Israel and Palestine: Quartet

Lord Hylton: asked Her Majesty's Government:
	What is the current policy of the quartet with regard to Israel and Palestine; and whether it has evolved since the Annapolis conference.

Lord Malloch-Brown: My Lords, despite many challenges, the Annapolis process continues to offer the best opportunity to achieve a sustainable, two-state solution. The quartet's policy remains to support the process, including the ongoing dialogue between President Abbas and Prime Minister Olmert and wider negotiations between their teams. As the quartet noted in its statement following its 2 May meeting in London, there has been progress. However, it is evident that much remains to be done.

Lord Hylton: My Lords, I thank the noble Lord for his reply. Surely current policy should evolve from past failures. Does he agree that, for years past, the rest of the world has been paying the economic and social costs of Israeli occupation and colonisation of the West Bank and Gaza? To mention just one factor, the budget of UNWRA for the current two years is more than $1 billion. Should not these matters that are so vital to world peace now be urgently reviewed?

Lord Malloch-Brown: My Lords, the noble Lord is of course correct that the cost of the Middle East conflict has been huge, not only to those immediately involved—Israel and its Palestinian neighbours—but to the broader donor community. We therefore all wish to see a resolution. The British Government have been quick to promise that, in the context of such a resolution, we would be generous supporters of peace and reconstruction within a two-state solution. This has been a long-standing and intractable problem, but I repeat that the Annapolis process and the quartet's support for it offer a better path to peace than any other currently available.

Lord Wallace of Saltaire: My Lords, the US Secretary of State yesterday attacked the Israeli Government for continuing to expand settlements, particularly around Jerusalem. Is this the declared policy of the quartet? Will the quartet make known to the Israeli Government its concerted views about the unhelpfulness of this continued settlement expansion?

Lord Malloch-Brown: My Lords, as the noble Lord is aware, the quartet has always been opposed to illegal Israeli settlement and has recognised that it is an obstacle to peace. It is not for me to say whether the quartet would adopt the specific terms used by one of its members yesterday, but opposition to settlements has been a continuous part of quartet policy.

Lord Anderson of Swansea: My Lords, does my noble friend agree that it would be helpful not to be one-eyed and selective in our approach and to recognise that, when Israel withdrew unilaterally from Gaza, it was rewarded with a rain of rockets on its territory? Given the facts of the Annapolis initiative, when Condoleezza Rice said that there would be a solution by the end of the year, whereas Mahmoud Abbas has been highly dubious and downbeat of late, where do Her Majesty's Government stand in the spectrum? Is there any serious prospect of a solution by the end of the year?

Lord Malloch-Brown: My Lords, Secretary Rice is the leader of the realist school of American foreign policy. Therefore, if she is optimistic, that gives us all some cause for hope. Obviously there are huge hills to climb between now and the end of the year, but I would put myself in the diplomatic camp known as "eternally optimistic".

Lord Howell of Guildford: My Lords, the settlement situation that has been referred to is deplorable, particularly as part of Annapolis was that illegal settlement should be halted. That there should be building in the disputed areas of Jerusalem is miserable and I hope that we have made representations about it. However, perhaps I may turn to a slightly more hopeful aspect of Annapolis: the dealings between Israel and Syria on the Golan Heights and a move towards a more reasonable Syrian position generally on both that and Lebanon. Will the noble Lord tell us a little more about that? What contributions are the British making towards that more hopeful development?

Lord Malloch-Brown: My Lords, my right honourable friend the Foreign Secretary made a visit to the region, although, unfortunately, as I told the House last week, he had to come back before the Israel leg of it. However, the visit allowed him to focus on these wider issues of Lebanon and Syria. He was there to show that we support progress for peace on both those fronts.

Baroness Williams of Crosby: My Lords, does the Minister agree that one of the great problems with the continuation of the settlements and the line of the security wall is that the possible other independent state—the Palestinian state—is becoming increasingly economically unviable and, indeed, agriculturally unviable given the position of the aquifer? Can he give us any assurance that, in the Annapolis talks and their sequels, serious consideration is being given to how one can retain economic viability in this second independent state?

Lord Malloch-Brown: My Lords, we are not privy to all the internal discussions in the Annapolis process, which is a closely held one, but the economic viability of a Palestinian state is a core concern; it is particularly the preoccupation of Tony Blair in his role. I think that everybody agrees that the wall is not a long-term solution or part of a secure, safe and mutually recognised two-state solution.

Lord Elystan-Morgan: My Lords, does the Minister recollect that, within the past fortnight, the head of state of a neighbouring Muslim country said that Israel will soon die and as a geographical entity will be expunged? Do not those words reflect the true jeopardy in which Israel still lives, 61 years after being formed as a sovereign state?

Lord Malloch-Brown: My Lords, the noble Lord is of course correct to remind us all that not everybody by any means in the Middle East yet even accepts the right of the state of Israel to exist. That is why it is such a closely held principle of the quartet that recognition of the right of Israel to exist is an absolute predeterminant and necessary condition for peace.

Baroness Symons of Vernham Dean: My Lords, particularly following on that last question, maybe it is as well to remember that it was the current King of Saudi Arabia, when Crown Prince, who espoused the two-state solution very early on in this process. Can my noble friend tell us what direct economic and political support this process is receiving from Arab countries, in particular Saudi Arabia, the United Arab Emirates, Egypt and Jordan?

Lord Malloch-Brown: My Lords, rather than giving the noble Baroness an incomplete answer, I shall write to her with details.

Baroness Tonge: My Lords, does the Minister agree that Israel is—

Noble Lords: Order!

Defence Industrial Strategy

Lord Astor of Hever: asked Her Majesty's Government:
	Whether it is still their intention to publish a revised version of the defence industrial strategy; and, if so, when.

Baroness Taylor of Bolton: My Lords, I am sure that the whole House will wish to join me in offering sincere condolences to the families and friends of Lance-Corporal James Bateman and Private Jeff Doherty of 2 Battalion the Parachute Regiment, who were killed on operations on Thursday 12 June in Afghanistan.
	We remain committed to the defence industrial strategy and are working closely with industry to develop it further. We continue to review with industry the timetable for the publication of the planned update. A date has yet to be determined and I will keep the House informed.

Lord Astor of Hever: My Lords, we on these Benches join the noble Baroness in sending our condolences to the families and friends of Lance-Corporal James Bateman and Private Jeff Doherty of 2 Battalion the Parachute Regiment. She says that the Government remain committed but since the departure of the noble Lord, Lord Drayson, it appears that work in the MoD on a revised DIS has been derailed and that, as we feared, the civil servants are triumphing. Is she aware—I am sure she is—that this is causing great uncertainty for industry, particularly for SMEs? Can she assure the House that she will now give a clear sense of direction to the Government's defence industrial strategy, particularly where it relates to the further implications of partnering with industry and retaining our sovereign capabilities?

Baroness Taylor of Bolton: My Lords, I can certainly tell the House that the whole of the MoD, including civil servants, is very committed to the defence industrial strategy and that a great deal of review work is being undertaken sector by sector in close conjunction with industry. The most recent workshop, in which we discussed operational sovereignty, occurred just two weeks ago. Very senior people—key players in the defence industry—were present and fully involved, which proves the commitment on the part of industry and of the MoD.

Lord Lee of Trafford: My Lords, we on these Benches wish to be associated with the tribute. Given the tremendous pressure on the defence budget, does the noble Baroness not find it somewhat ironic that most defence contractors, whether they be involved in manufacture or outsourcing, are making record profits and that that sector is very highly rated by the stock market? Given that the Government's policy is one of partnership with the industry, and while we want a prosperous defence industry, does she consider that the present risk/reward ratio between government and industry, both in terms of profits and penalties, is fair?

Baroness Taylor of Bolton: My Lords, the noble Lord refers to a problem that has existed for all Governments for many years; that is, how to ensure that we have a thriving defence industry while also ensuring that the taxpayer gets good value for money from contracts. By working in new ways with the defence industry and having different types of contracts, be they PFI deals, partnering or leasing arrangements, the MoD is able to work out what is appropriate for each capability. All the time we are looking at new ways of ensuring that we get best value for money so that we can provide our Armed Forces with the capabilities which they need.

Lord Foulkes of Cumnock: My Lords, is my noble friend aware that many of us on this side are grateful for the fact that for the past 11 years we have had a Government who have a defence industrial strategy? Will she confirm that the potential award of the contract for the two aircraft carriers will provide jobs throughout the whole of the United Kingdom, including Scotland, but that the jobs in Scotland could be put in jeopardy if the SNP were to have its way and get a separate Scotland? Will she also confirm that these jobs represent an important part of the union dividend?

Baroness Taylor of Bolton: My Lords, I confirm that I know of no plans by the SNP to build any aircraft carriers in Scotland, or indeed anywhere else. We have made significant progress with the maritime industrial strategy, which will be underpinned by the decision to go ahead with the carriers, and we are now waiting for the joint venture company to fulfil its further legal agreements before the next stage. A lot of jobs will be created in all parts of the United Kingdom.

Lord Campbell of Alloway: My Lords, as the defence industrial strategy is related to procurement, on which there is a Question tabled for Answer on 7 July, will some information as to the revised version be available by then? I have forgotten the previous Minister—

Baroness Sharples: The noble Lord, Lord Drayson.

Lord Campbell of Alloway: y Lords. He devised this defence industrial strategy so the revision in outline would be greatly appreciated before 7 July.

Baroness Taylor of Bolton: My Lords, I said earlier that I could not give a specific date. All I will say is that the discussions with industry are taken very seriously by both sides, and I hope that we will make very good progress and have a document that is well worth all the effort that both industry and the MoD have put into it.

Earl Attlee: My Lords, is it correct that the Strategic Defence Review announced the carriers and that it has taken over 10 years to place a production contract for the vessels?

Baroness Taylor of Bolton: My Lords, the decision to go ahead with the carriers was first made in July last year, so I do not think that there has been undue delay since then.

National Security: Electronic Attacks

Lord Soley: asked Her Majesty's Government:
	What is their assessment of the electronic attacks against the United Kingdom's critical national infrastructure and the countries from which these attacks originate.

Lord West of Spithead: My Lords, electronic attacks have been directed at various organisations globally, including elements of our national infrastructure, for criminal and other purposes. They may emanate from many parts of the world, and it can be unclear where responsibility lies. Such attacks involve unauthorised access to computers and networks with the intent of stealing data or disrupting services. It is not in the interests of our national security to confirm or deny attacks against specific organisations.

Lord Soley: My Lords, I am grateful for that reply. As my noble friend knows, it is a complex area, but I understand that there have been attacks on some legislative bodies around the world. Whether they come from organisations or nation states is hard to know. Should we be discussing an international treaty or legislation to deal with this when it is done by Governments as opposed to organisations?

Lord West of Spithead: My Lords, some interesting points have been raised on this important and dangerous area. There is no doubt that as we become more interconnected—as we are in terms of links to the internet, webs, and so on—we become more vulnerable. In a funny way when one is no good with computers and they are not linked, there are air gaps.
	There are a large number of attacks but it is not in the interests of national security to be specific about who has been attacked or when because that would give away techniques and skills. We talk internationally about this. I was in Canada and the United States two weeks ago, and cybersecurity and e-crime—identity theft—were discussed at length. They were also discussed last week at the G8 in Tokyo. The G8 sponsors the Meridian process, where we discuss all these issues. It is something that worries other nations particularly. We were more aware before and they are now much more so. There was an attack in Estonia. It is an issue we should be worried about and we give lots of advice on it.

Baroness Miller of Chilthorne Domer: My Lords, the Government are on record as saying:
	"The integrity of electronic communications networks and services is a matter for communications services providers".—[Official Report, Commons, 31/1/07; col.316W.]
	Is that not a bit of a laissez-faire attitude? Will the Minister say whether there has been an increase in personnel since the National Infrastructure Security Co-ordination Centre merged with the National Security Advice Centre last year?

Lord West of Spithead: My Lords, the noble Baroness raises an important point. We give a lot of direct support. We have computer emergency response teams for Government and the public sector. We have GovCertUK, which is based on GCHQ, and the CESG. For the private side CPNI has a combined security incident response team which gives advice. We give guidance on the Security Service, CPNI, GCHQ and Get Safe Online websites. The message I want to get out to everyone, to big industrial firms, SMEs and private individuals, is that they need to think very hard about this. If you are connected to the web, people can get into your computer. The only sure ways of stopping that are air gaps, firewalls and having things enciphered. All these things help and all of us need to do them. We are very joined up now and a lot of data are given away if we are not careful. That is why we are taking this so seriously. An awful lot has been done since last June. I focused on this particularly when I came into post. We discussed it in a Cabinet meeting two months ago and I think we are going in the right direction.

Lord Elton: My Lords, the Minister has reeled off a whole galaxy of organisations, bodies and committees which are interested in this. Who has ministerial responsibility for this and what central point in Government is co-ordinating all this effort so that it makes sense and has effect?

Lord West of Spithead: My Lords, I am sorry I banged on a little long, but I get quite excited about this subject. The Central Sponsor for Information Assurance lies within the Cabinet Office. But since my appointment last June, this has been an area that I am particularly interested in. Many nations are very vulnerable and we need to look at it very closely.

The Countess of Mar: My Lords, can the Minister assure us with absolute confidence that the national identity register, the National Health Service register and particularly the children's register will be totally secure from people who want to crash into those networks?

Lord West of Spithead: My Lords, without knowing the exact detail, hand on heart, the only way you can be totally sure that no one with remarkable skills can get into a system is if there is an air gap. I do not know the situation regarding those registers but I will get back to the noble Countess in writing. If there is an air gap, it is impossible to get into a system. If you are connected, I am afraid, and if you have real capabilities, at the end of the day it is possible.

Baroness Hanham: My Lords, I appreciate that this is probably a very difficult area for legislation, but is the Minister satisfied that, if anybody is caught carrying out either cybercrime or cyberterrorism, there is suitable legislation under which they may be prosecuted?

Lord West of Spithead: My Lords, one of the problems is that this comes from all parts of the world and it is quite difficult to achieve what the noble Baroness suggests. Certainly our discussions with the G8 and internationally are aimed at making sure we can grab these people who range from individual hackers, who sometimes just want to cause damage—they have done some quite nasty things in the past to various countries—through to state-sponsored issues. For the purpose of national security one cannot talk about those at the moment, but we are taking action on them. It would be extremely difficult to put a lot of people on trial, where they deserve to be.

Lord Roberts of Llandudno: My Lords, many new databases have been established, such as the national dismissal register. What do we have to monitor the various independent databases to make sure that they come within the Data Protection Act and other legal requirements?

Lord West of Spithead: My Lords, in terms of those databases coming within the Data Protection Act, they are monitored. If those systems are attacked, we give advice, and if someone believes they are being attacked, we will look into it. I would not want to go any further into what we can achieve in knowing whether something has been attacked and penetrated.

The Earl of Northesk: My Lords, is the Minister satisfied that advisories and patches issued by the likes of CPNI and UKCERT are issued in an adequately timely and proactive way, as, for example, with the current vulnerabilities relating to SCADA—the Supervisory Control and Data Acquisition system—and certain elements of the CNI?

Lord West of Spithead: My Lords, in the past we perhaps have not been as timely as we should have been. That has now rapidly been caught up. We had a Cabinet meeting only recently. It is an issue that I have taken a lot of interest in and we are gaining ground. It is important that that information is given in a timely way and it is my intention that that should be done. But this is a very difficult and complex area and the more joined up and capable we become at talking to each other on all these systems, the more vulnerable we become, which is why one has to put in place very strict rules, monitor them, and do all the other things necessary to protect them.

Health: Sickle Cell Disease

Lord Smith of Clifton: asked Her Majesty's Government:
	What steps they are taking on the prevention, management and rehabilitation of strokes in children with sickle cell disease.

Baroness Thornton: My Lords, the Government support a number of initiatives in this area. We have introduced antenatal and neonatal screening programmes for sickle cell disease, and the Department of Health is implementing a training programme in scanning for stroke risk. Furthermore, we support the national standards and guidelines for the clinical care of children with sickle cell disease and the use of the Royal College of Physicians' guidelines for the management of strokes in children.

Lord Smith of Clifton: My Lords, I thank the Minister for that reply. In answer to a Written Question of mine on this subject, it was stated that strokes in young people was for the royal colleges, while, thankfully, the Department of Health has taken a lead in adult stroke strategy. Why is there that difference? Is it a symptom—I hope to be assured that it is not—of racial discrimination within the National Health Service, because, of course, the vast majority of strokes in children are in young sickle cell patients of Afro-Caribbean origin? Secondly, will the Minister assure us that central government funds will be forthcoming to ensure that all sickle cell children are offered screening for stroke risk and treatment with chronic blood transfusion, where appropriate, to prevent strokes?

Baroness Thornton: My Lords, I thank the noble Lord for those questions. The Government support the existing guidelines that I have already referred to. Indeed, he will be aware that the majority of people who have strokes are over the age of 55; some 110,000 adults have strokes and approximately 400 children had strokes last year. Prevention of strokes in children and managing their rehabilitation after a stroke is very different as compared with adults, but that does not mean that we do not have to have a strategy in place for dealing with that. Preventing strokes in children with sickle cell disease requires repeated blood transfusions and even bone marrow transplants, which may be appropriate. The different approach required for the management of the rehabilitation of children affected by strokes needs to be run by a consultant paediatrician and a haematologist. It is covered, therefore, by the guidelines published by the Royal College of Physicians.

Lord Walton of Detchant: My Lords, does the Minister agree that this disease is the result of a genetically determined abnormality of the red blood cells that almost exclusively occurs in people of Mediterranean and African origin? In consequence, the cells which develop this sickle-cell shape tend to clump together and damage the internal lining of the arteries that supply the brain, and that is the principle cause of stroke. In order to be able to detect this risk, ultrasound scanning is necessary, and there is clear evidence from recent American research that the risk of stroke in such individuals, particularly in children, can be reduced by about 90 per cent by regular monthly blood transfusions. Is she satisfied that there are adequate facilities in the NHS for that ultrasound scanning and regular transfusions?

Baroness Thornton: My Lords, the noble Lord is absolutely correct and has given the House a very helpful summary of the issues. We are working, through the Sickle Cell and Thalassaemia Screening Programme to agree standards, testing protocols and a standardised training scheme to ensure the establishment of appropriate scanning with transcranial Doppler scans. These, as well as lifelong blood transfusions, are key parts in the management and prevention of strokes in children with sickle cell disease. The Government are working to ensure that over the next year a regional service should be available throughout England.

Baroness Trumpington: My Lords, is there any liaison between this country and a clinic in Jamaica, which I have visited, devoted to the treatment of and research into sickle cell disease? The clinic is doing valuable work in a country which, after all, has to live with the disease. I would be very interested to hear the Minister's reply.

Baroness Thornton: I should be surprised if that were not the case, although I shall write to the noble Baroness to confirm that. We are working with American colleagues to ensure that the specialist care for these children is developed.

Baroness Whitaker: My Lords, following the question of the noble Lord, Lord Smith, about discrimination, can my noble friend tell me if there is an overall strategy relating to sickle cell anaemia as a whole?

Baroness Thornton: My Lords, we have been involved in developing a strategy and implementing a number of services for patients with sickle cell disease. These include the implementation of the programme of transcranial Doppler scanning; the establishment of managed clinical networks; the funding of training posts for registrars, nurse consultants and clinical scientists; the recognition by the royal colleges of the need to increase training in sickle cell disease, including changes to the examination syllabus for doctors and health professionals; and the funding of a database to track patients in the care they require.

Baroness Barker: My Lords, the incidence of this disease varies greatly. Seventy per cent of people who suffer from it live in London. Are PCTs in areas where it is prevalent given additional funding to enable them to purchase specialist services and care?

Baroness Thornton: My Lords, they are being given additional funding. I do not have the figure in front of me at the moment, but I can write to the noble Baroness.

Earl Howe: My Lords, the Minister will know that many children with sickle cell disease suffer a series of silent strokes which are often not detected until a full-blown stroke occurs. These silent strokes are detectable through changes in the child's behaviour—for instance, drowsiness—and in their handwriting. What is being done by the Government to ensure that the education services and teachers are aware of the needs of pupils with sickle cell disease?

Baroness Thornton: My Lords, I do not have a detailed answer about the education service. The National Health Service has been publishing information about this, and it is being used in the areas of the country where sickle cell disease is prevalent.

Business

Baroness Royall of Blaisdon: My Lords, with the permission of the House, at a convenient point after 4 pm, my noble friend Lady Taylor of Bolton will repeat a Statement on Afghanistan. Immediately after this, my noble friend Lord Hunt of Kings Heath will repeat a Statement on the funding and expenditure of political parties. This will be followed by a Statement on the Lisbon treaty repeated by my noble friend Lady Ashton of Upholland.

Health and Safety (Offences) Bill

Brought from the Commons; read a first time, and ordered to be printed.

Crossrail Bill

Baroness Royall of Blaisdon: My Lords, I beg to move the Motion standing in the name of my noble friend Lord Bassam of Brighton on the Order Paper.
	Moved, That it be an instruction to the Grand Committee to which the Crossrail Bill has been recommitted that they consider the Bill in the following order:
	Clause 1
	Schedule 1Clause 2Schedule 2 Clause 3Schedule 3Clause 4Schedule 4Clause 5Schedule 5Clause 6Schedule 6Clauses 7 to 10Schedule 7Clauses 11 to 15Schedule 8Clause 16Schedule 9Clause 17Schedule 10Clauses 18 to 45Schedule 11Clause 46Schedule 12Clause 47Schedule 13Clauses 48 and 49Schedule 14Clause 50Schedule 15Clauses 51 to 58Schedule 16Clause 59Schedule 17Clauses 60 to 67.—(Baroness Royall of Blaisdon.)

On Question, Motion agreed to.

Health and Social Care Bill

Report received.
	Clause 1 [The Care Quality Commission]:

Lord Lipsey: moved Amendment No. 1:
	Clause 1, page 1, line 9, at end insert—
	"(2A) Subsections (1) and (2) shall not have effect until the Secretary of State has made a statutory instrument containing an order to that effect.
	(2B) A statutory instrument shall not be made under subsection (1) unless—
	(a) the Secretary of State has commissioned a review, to be prepared with the aid of an independent assessor, of the case for and against, and alternatives to, the merger of the Commissions referred to in subsection (2),(b) the Secretary of State has published an assessment of the outcome of that review, and(c) a draft of the instrument has been laid before, and approved by a resolution of, both Houses of Parliament.
	(2C) The assessment referred to in subsection (2B)(b) must be published within three months of the passing of this Act."

Lord Lipsey: My Lords, in view of the fact that I have chosen "Statement afternoon" to do so, I seek not to detain the House for any more time than is necessary to move this amendment. I am sorry to have provoked a mass walk-out before I have said anything controversial. Later on, such few members of my audience as remain will no doubt join those who are departing from the Chamber. I will be reasonably brief and in order to be reasonably brief, I shall not spell out yet again the case for my amendment. At Second Reading I set out the case for not proceeding with this amalgamation and a number of noble Lords backed that in Committee. This really is the most modest amendment imaginable to deal with the difference of opinion over amalgamation. All I am asking is that when the Bill has gone through, Ministers spend a month or two taking another look at the arguments for and against and decide whether the amalgamation really is in the public interest. I could not do that myself because I am deeply committed to the view that it is not in the public interest. If the noble Lord, Lord Darzi, who has been very attentive and kind in listening to my arguments on this case, said, "I will do that", all will be done and dusted—the Government could just go ahead and do that; the amendment is not needed in the Bill.
	I will not make the case for why we need the amendment but I will deal with the case for "Why not the amendment?". What has persuaded Ministers on this? I believe them to be persuaded; the noble Lord, Lord Darzi, is a surprising and honest man and he sometimes does surprise us but my understanding is that he is not likely to support the amendment. I will go through the arguments against. I am sorry if I am taking the noble Lord's thunder in doing so. I was taught in my days in politics that you should always get your retaliation in first.
	There are three arguments for not adopting the amendment. The first, which was set out in a letter to me from the Minister in another place, Ben Bradshaw, is that it will cause disruption to the staff of the three organisations being amalgamated; that is, delay will totally unsettle them and they will all go off and get other jobs. Many noble Lords have experience of amalgamations, mergers, changes in structure and so on and they will have heard this argument time and again. My experience is that it is invariably hugely exaggerated. With regard to the people in the Commission for Social Care Inspection, my understanding is that there are not an awful lot of jobs as social care inspectors going begging to which they could rush because there had been a month's delay while the arrangement was being looked at again. As some noble Lords will know, I am quite involved—one of my less serious aspects—with horseracing and the Tote. For years—since the Labour Government first promised, in, I think, 1997, to sell off the Tote to the private sector—its employees have been in a state of suspension, not knowing whether the Tote would exist or whether their jobs would exist. Meanwhile, the Tote has gone from strength to strength: its profits rise and the number of employees leaving is not very different from the figures for anywhere else in the world. It manages to cope with uncertainty. Uncertainty is a fact of human life and most of us cope with it perfectly well. If the staff of the three agencies concerned were under tremendous pressure to go and work somewhere else I would understand the worry involved, but we are talking about only a month or two, so that is not a plausible reason, although it is the kind of reason that invariably finds its way into ministerial briefs. It is not true that uncertainty is involved.
	The second argument against the very short delay that I have proposed is that the Bill has gone through the House of Commons, which expressed its opinion on the subject and passed the proposal, and it is not therefore for your Lordships' House to stand in the way of the expressed will of another place. I will make two points on that. First, if I were a more eloquent person than, alas, I am, and I had managed to persuade Ministers that having another look at the whole thing was the right way forward and that we should therefore have a delay, would Ministers worry for a single second that there had been a vote in another place in favour of the proposal? Of course they would not; they would just say, "We have thought further and we are changing this", and they would go back to another place, which would be happy to accept that, and it would be agreed to. This is really is a piece of constitutional dogma masquerading as an argument to suit ministerial convenience, and it will not for a moment wash.
	In any case, let us suppose that we ran a political system where Ministers were, one way or another, incentivised to resist all possible change to all possible Bills by whatever forces—perhaps the Civil Service, perhaps other bodies, I do not know. If we ran a sensible system, it would operate as follows. The Bill would go through the House of Commons. Thereafter, it would be clear that there was not consensus in favour of what the Government were proposing and there would be arguments either way. It would therefore make perfectly good sense to have another, final, brief look at the Bill before deciding to proceed with the policy. There would be no need for an amendment to the Bill; there would be a commencement date and Ministers could decide not to commence if they were convinced that it was not the right thing to do. That may seem like constitutional outrage to some people here, but it seems to me a sensible way of doing business.
	The third argument that I have heard advanced—I hope I am wrong about this in some ways—is that the new commissions have been agreed by the noble Baroness, Lady Young of Old Scone. She will be the chair of the new organisation and she has done it on the basis that what she is going to get is what is in the Bill and that it cannot be changed. Here I admit to a difficulty, because if anyone is going to take on this mess, I would prefer it to be the noble Baroness, Lady Young of Old Scone. It anybody can make silk purses out of sows' ears, she is the person I would back to do that.
	This goes back to the point that I made in Committee—when other noble Lords agreed—which is that putting in place a chair before a Bill has gone through the House shows a lack of wisdom. I raised the point with Ministers at the time and they said that it is not unprecedented. Of course it is not unprecedented and sometimes it makes very good sense. But when an issue is live in this House, it seems extremely unwise to agree a whole set of conditions with somebody under which they will take it, dependent on the Bill remaining unchanged, when the Bill has yet to be put before the House and the opinion of the House on it remains to be tested. I do not blame the noble Baroness, Lady Young of Old Scone, for insisting that she must have a free hand on the structures of what is going to go into this and that we cannot have any doubt whatever that it is going to go ahead. If I were in her shoes, which thank God, I am not, I might possibly take the same view.
	However, it leaves the House in a most paradoxical position. If every single Peer in this Chamber now and hundreds more go into the Content lobby this afternoon, and if the noble Lord, Lord Darzi, the noble Baronesses, Lady Thornton and Lady Young of Old Scone, are in the Not-Content lobby, the view of the hundreds will count for nothing because they will send it back to the Commons who will send it back to us as originally drafted and we will have achieved nothing. That does not show the respect for this Chamber that I should have hoped from these Ministers and this Government. We should be able to make our views clear and we should be able to do it without the effective veto that I have just described.
	I have reflected hard as to whether I should seek the opinion of the House on the Bill. On fine balance, I have concluded that that would not be the right thing to do. My amendment simply asks Ministers to look at this again. It may seem to be a tremendous demand but that is all I am asking. If Ministers oppose this today, even if we pass it in the House, it is a complete waste of time asking them to look at it again because they will look at it with a closed mind. Even if they do not send the Bill back to the other place and we submit it, all they will do is say, "We were right all along". Ministers usually say that, and that is all that will happen if we vote them down this afternoon. Therefore, I shall not seek to divide the House this afternoon.
	I have put my case as clearly as I can and I think that there has been some sympathy for it on all sides of the House. I just ask that before Third Reading Ministers look one more time at the arguments that have been put and at the weakness of the arguments that they have made the other way. I ask them to consider whether they can agree to my proposal or to a variant of it so that, if we go ahead, such a proposal will have the full consensus not only of this House but of the wider regulating community, and we will all be able to go forward in harmony. I beg to move.

Baroness Barker: My Lords, I have considerable sympathy for the arguments advanced by the noble Lord, Lord Lipsey. I agreed with him when we discussed these matters in Committee, and my reason for speaking now is to acknowledge the part that he, along with other Peers, has played in what has been a most interesting and dynamic process of change around this Bill over the past three weeks. During the Committee stage, great wisdom was brought to the subject by Members of this House and by Ministers and the Bill team because they listened carefully to the arguments.
	To place the amendment of the noble Lord, Lord Lipsey, in context, one needs to look at the next three groups, which contain significant changes to the Bill. That they have happened is, in part, due to the pressure applied by the noble Lord, Lord Lipsey, among others, and we should acknowledge that.
	I have extensive experience of being involved in mergers and I agree with the noble Lord that some of the arguments that have been advanced against a delay are not strong. However, although his amendment will not be passed by the House, it affords us an opportunity to ask for one thing. Before we get to Third Reading, this House should ask the existing commissioners to meet Members of the House to enable us to answer the question which, as is evident from the amendments before us this afternoon, has not yet been answered adequately—that is, what form should the commission take? We agree on the overall, broad, outline structure of the commission but it is clear that no one in this House has sufficient experience as a regulator in this field to know what the commission's precise structure and format should be. As a result of the discussions that we had in Committee, we now know what we want the commission to do and we now have a set of objectives, which will be put forward by the noble Lord, Lord Darzi, in a few minutes, with which we can agree, but we still have a doubt about how the experience of CSCI, the Healthcare Commission and the Mental Health Act Commission can most effectively be brought together in this new body. I hope that I am not putting words into his mouth but I suspect that the noble Lord, Lord Lipsey, would wish to see that process take place between now and Third Reading. If that is his intention, he has my support and I thank him for raising the matter.

Lord Harris of Haringey: My Lords, I have enormous respect for the noble Lord, Lord Lipsey—at least, I always have done in the past and I have known him for a disconcertingly long period. However, the arguments that he put forward this afternoon in support of his amendment, which he told us at a very early stage in the discussion he was not intending to press to a vote, were perhaps some of the weakest that I have heard in your Lordships' House. First, he employed a traditional gambit, which is to set up the arguments that you say that the opposition to your proposition are going to put forward and then knock them down, but not necessarily set out the most convincing of those arguments, but simply knock down three almost at random. Even when the noble Lord knocked them down, I found it slightly less than convincing.
	He said that it is universally the case that the problems of delaying an amalgamation are exaggerated. Like the noble Baroness, Lady Barker, I have had considerable experience of mergers and amalgamations. I can tell him what happens when there is a period when nothing much is happening. People obsess about the implications for them personally. It does not necessarily mean that they rush to the nearest appropriate or inappropriate job, but they obsess about it. They obsess about the positioning of the desks, who has the largest room, and whether the carpets and natural light will be as good, together with all the substantive issues that ought to concern them.
	Were the noble Lord to press the amendment to a vote—he has already told us that he will not—and it was passed, its effect would be to produce a period of three months in which very much less work would be done by either the predecessor commissions or the new commissions, because people would be obsessing about minor details. That in itself would be an unfortunate consequence.
	There might have been a very good case for the amendment had the Government not already listened to many of the points made in Committee. When the Bill passes from your Lordships' House, we will have a very different Bill in terms of how the commission is set up and the objectives before it. Had that not happened, a case for delay—three months or maybe even more—might well have been justified, but the Government have listened and have responded. They have changed the focus of the commission; they propose to give it a whole set of clear objectives; they will have improved the Bill substantially. The main argument in favour of the amendment moved by the noble Lord, Lord Lipsey, has disappeared.
	The noble Lord then gave us two other arguments that I cannot believe that my noble friend Lord Darzi was going to put forward: the fact that the House of Commons has spoken and the fact that the noble Baroness, Lady Young of Old Scone, has been appointed. Those arguments are not relevant to this point. The question is: do we believe that the commission as now proposed makes sense? Even if we have some lingering doubts about it, everyone is now working on the basis that the new commission will be established. It is difficult to see what will be gained by further delay so that a slightly dubious process can be gone through in which someone will weigh up the arguments and the Government will respond to them—no doubt with the closed mind that the noble Lord, Lord Lipsey, described—apart from three months of attrition while people contemplate their navel rather than carry out the health and social care inspections that are so important and so needed.

Baroness Howarth of Breckland: My Lords, I shall speak briefly on the amendment, because I, too, have lived through change; I have lived through the change of the National Care Standards Commission becoming CSCI. I will not repeat the arguments of the noble Lord, Lord Harris of Haringey, because he described clearly the kind of attrition that happens in organisations. I know that at the moment life is not easy at present in the Commission for Social Care Inspection in terms of staff changes and staff unease.
	I admire the noble Lord, Lord Lipsey, hugely, because I was one of the people who spoke most vehemently about the need to prevent this change and, if we could not prevent it, to delay it. However, we are where we are. The Government have moved significantly. I say to the noble Baroness, Lady Barker, who has also made a huge contribution to the movement on the Bill, alongside the Ministers, that I hope that we make further movement on Report. That is what will convince us that the Bill will truly reflect the positions of health and social care going forward together.
	As I have said, although this is about inspection, services will follow some of the issues designated by the inspections and we should not delude ourselves that they will not be greatly influenced by the way inspection goes—indeed, I hope that they will be. I am immensely grateful for all that the noble Lord, Lord Lipsey, has done to move this forward. However, because of the problems that a further delay would cause, I agree with the noble Lord, Lord Harris.

Lord Ramsbotham: My Lords, I forecast that I would put my name to this amendment when we discussed the issue in Committee. I have listened to what has been said by the previous speakers on the question of delay. There are two reasons that worry me deeply about where we are. Neither of them, perhaps, arises straight from the Bill, but they are related to it.
	The first is the word "inspection", recently used by the noble Baroness, Lady Howarth. I reminded noble Lords in Committee that there are three separate functions involved in the role that we are discussing for the commission: regulation, audit and inspection. They are all needed and they are all different. The differences between them include the fact that it is proper for Ministers to be involved closely with both the regulation and audit of the structure and system. Ministers are involved in making the regulation in the first place, and in its performance as well. The audit will probably be of something that is ministerially ordained. However, inspection must be independent and objective if it is to be proper. It must not do anything to damage its objectivity in the eyes both of those being inspected and of the public, to whom reports are made.
	What worries me about the establishment of the commission is that independence of that kind—the reporting of facts, independently judged—is not something that I see there. That is one reason why I am sorry at another casualty of the Chancellor's Budget speech of 2005, which first saw the demise of both children's care and mental health care under Ofsted. Now we have seen the demise of the rest of the independent inspectorate of adults, which has been rolled into another huge commission. My concern is as much about what has happened to the care and mental health support for children, because at the time there was not the same degree of fight about it as we had over the proposed inspectorate for justice, community safety and custody. At least the Government had not appointed a chief executive of that before it came to this House. In the Budget speech of 2005, the Chancellor announced the merger of these public sector inspectorates and described it as a cost-saving exercise. There is no cost saving at all. What has emerged from this Bill is evidence that you must have people in the commission dealing with social care, mental health care and healthcare to make it work. One has to support the noble Baroness, Lady Young—I understand all that she must be going through while this is dissected in front of her. However, this is not going to save anything.
	My second concern is "compromise". Although compromise may look convenient, it inevitably weakens all the parts that are being compromised. In 1996, when I was the Chief Inspector of Prisons, all the chief inspectors involved in the criminal justice system—the chief inspectors of prisons, the Probation Service, the police, court services, magistrates' courts, and social services—looked at working together to see what things that needed to be reported on could be done together. The first thing we came up with was to ask: what information did each inspectorate need of each other in order to do the job properly; what information was available; what was difficult to get; and what was not available and why? We published this in a report that we put before Ministers saying, "This is an example of six different organisations coming together to tell you what is needed in order to improve the processes in the areas you are responsible for". Where is that report? It is sitting on a shelf, because none of the Ministers involved was willing to take responsibility for seeing that all the others worked together.
	What worries me about this proposal is that we are in the same situation and that the casualty will not be a paper put together on the subject of information, but social care for children and for the elderly. Therefore, while I hear all that has been said about how everyone wants to get on with this without delay and the problems of amalgamation, I beg that before the Government go ahead they are satisfied that all the casualties along the way have been properly catered for so that we do not end up with a compromise of three different systems, that we have not damaged others, and that we and the people we are responsible for providing health and social care to do not end up in a worse state than before the whole exercise started.

Baroness Wall of New Barnet: My Lords, I support the comments of my noble friend Lord Harris and the noble Baroness, Lady Howarth, in particular around the argument that there is never a good time for change. They both spoke about the changes that they have been involved in, and I too could relate the events involved in several changes. My noble friend Lord Harris gave us a good flavour of the effect of such changes. However, what has not been mentioned is that such a delay would be absolutely catastrophic for patients who are affected by the commission. They would be waiting, like everyone else, to see what came out of the review. It would be unforgivable for Members of this House to get involved in aspects of deliberation and argument that overlook the whole reason that the Government put together the main bodies that will form the new commission. If the noble Lord, Lord Lipsey, has any doubts or second thoughts, he should not press his amendment—I am sure that he will not do so—for that reason alone.

Lord Warner: My Lords, I rise briefly to oppose, uncharacteristically, an amendment tabled by the noble Lord, Lord Lipsey, with whom over the years I have usually been in common accord. I do so as the then Minister who, in the way of the pantomime villain, actually proposed the merger of these three bodies. However, it is worth bearing in mind that that was as long ago as 2004, so the idea that this comes as a great surprise to everyone is a bit of a myth. The change was proposed for a number of reasons. It is fair to say, and with all due respect to the noble Lord, Lord Ramsbotham, that the work in the area of regulation and inspection that was done when I was a Minister revealed discernible mission creep in many of the bodies, as they say in the trade. They grew their functions and their budgets, and indeed many were rather skilful at doing do. There was a need to do a bit of horticultural pruning, and data collection was a good example. But to be fair to the health and social care organisations and some of the other arm's-length health bodies, they got together in order to reduce the huge diversity and increase the commonality of data collection. There have been improvements, although more could be made.
	Two areas with particular scope for improvement were commonality of approach and learning best practice in inspection and performance review from each other. The Healthcare Commission has done a great deal of work in this area, relying more on a risk-based approach and self-audit. CSCI could certainly learn a great deal from this. It is unfashionable to say, in any way, that any past body is less than perfect in every characteristic, but the truth is that bodies can learn from each other and improve their performance. Merging would here help to break down what Frank Dobson rather graphically called the Berlin Wall between health and social care. Merging the regulators is likely to help in that area.
	I recall, when the 2003 Act was going through, standing in the same position as the Minister and being rather chastised from the Benches opposite about the need to move towards a merger of these bodies in due course. Around 2003 there was a degree of enthusiasm—particularly from the Liberal Democrat Benches, as I recall—for moving towards merging these bodies. We have come a long way since then and there is now a good case for merging. It has not been sprung on everybody. I totally agree with my noble friend Lord Harris: my experience of managing change is not so much that people rush off to get other jobs; they rest on their oars, wondering when the change will come and what they need to do, rather than knuckling down to make it. That makes managing those changes very difficult.
	Finally, it is not for Parliament to micromanage change. This is the job of the Executive, once the decision has been taken to merge these bodies and the legislation has been passed. Parliament is not terribly well equipped to start determining the precise way to execute that change. By all means, criticise the Government if it is not done well, but for Parliament to intervene in that process is unlikely to be an effective way of securing good change.

Lord Low of Dalston: My Lords, I will say a word or two more in support of the amendment of noble Lord, Lord Lipsey, whom I must now learn to call my noble friend, before it is finally withdrawn. I recognise that the Government have moved a long way in response to the many arguments that have been deployed over this Bill in Committee. There would be merit in the Government acceding to his request, from this point of view. The noble Lord, Lord Warner, is absolutely right: this merger has not been sprung on us or taken us by surprise. It was announced in the Chancellor's Budget Statement in 2005 and, as I understand from the noble Lord, Lord Warner, it had been mentioned in dispatches before.
	Having been announced by the Chancellor in 2005, it has, as far as I can make out, largely been a fait accompli. It has been given to us by government fiat. We have made progress on a range of issues in Committee, as will become clear on Report. Curiously, the one issue that we have been tiptoeing around is the rationale for the merger itself. Concerns have been expressed, perhaps most volubly by the noble Lord, Lord Ramsbotham, who has a good deal of experience in these matters. Some noble Lords have had those concerns assuaged by the moves that the Government have made.
	However, lingering doubts remain and the Government could do themselves a considerable favour by acceding to the terms of the amendment in the name of the noble Lord, Lord Lipsey, taking a further a look at the issue and carrying out a quick review of the kind proposed. We have been moving towards consensus, so a review that sets out more fully and clearly than has happened to date the reasons for the merger and the benefits that it will bring could well help to seal that consensus and ensure that the new commission moves forward strengthened in the knowledge that it has the full weight of informed opinion behind it.
	Ministers will say that they spoke at length about this in Committee, but my recollection is that their responses largely took the form of saying, "Don't worry. We'll take the points you have made on board and attempt to deal with these matters through the way in which the commission is finally set up. You'll see the fruit of that in amendments on Report". However, we have not yet heard enough about the fundamental justification for the merger. At Second Reading and subsequently, I asked whether the Government had followed the recommendations of the National Audit Office for the merger of public sector regulators, whether they had undertaken due diligence, a cost-benefit analysis or a risk analysis, and whether they had established measurable success criteria for the merger. Unless I have missed something, I have not had a substantive response on those points. If we could get such a response by way of a review, that would ensure that the merged commission was much strengthened as it set out on its journey.
	Finally, I am not too worried by the concern expressed by the noble Lord, Lord Harris, in particular, that if the review were to take place everyone would become obsessed and count the paper clips and the position of the desks and so on. As far as I can see, they are pretty well in that condition already; there is a state of suspended animation in the present commissions. That would not be extended unduly if a quick review were to take place; indeed, it could bring this issue to a quick and reassuring end. I hope that the Minister will give serious thought to the amendment.

Lord Darzi of Denham: My Lords, I have listened very carefully to the concerns of the noble Lord, Lord Lipsey, and his proposals in Amendment No. 1 in regard to a further review before the establishment of the Care Quality Commission. Because of the timetable for establishment, such a review would ensure a delay in the establishment of the commission beyond April 2009. Of course I recognise that the establishment of any new body as large as this one is a significant exercise. As pointed out by the noble Baroness, Lady Barker, the contributions to date by noble Lords will undoubtedly make the commission a more effective organisation.
	However, there is an overwhelming reason why we should press ahead with the current timetable. Accepting the amendment would mean that Parliament would have to consider an independent review of the benefits of establishing the commission before agreeing to it by affirmative resolution. Although the timescale set out in the amendment suggests a rapid review, it is appropriate to remind your Lordships' House of the general support for the principle of bringing together health and social care regulation. As Anne Williams, president of the Association of Directors of Adult Social Services, said when giving evidence on the Bill:
	"so much provision is currently integrated and more and more will be ... The public want to be assured that one body is responsible, and that it does not duplicate or focus on different things".—[Official Report, Commons, Health and Social Care Bill, 8/1/08; col. 79.]
	As my noble friend Lord Warner also pointed out, we have already had extensive consultation on these proposals. Central to that ongoing process was the 2006 consultation, The Future Regulation of Health and Adult Social Care in England. That document sets out the benefits of bringing together the regulation of health and social care, such as enabling greater consistency of standards, inspection arrangements and performance assessment. The consultation showed that there was general support for the move to an integrated regulator. In particular, consumer organisations, which represent those people who use the services, see the case for having a single regulator because it will also provide a clear focus for the public, who often find the boundaries between health and social care artificial. We have been working very closely throughout the process with the existing commissions on transitional planning and workforce strategy to ensure that uncertainty is kept to a minimum. As Members of this House have already said, delay now would lead to increased uncertainty.
	My noble friend Lord Patel of Bradford pointed out in Committee that we risk losing the valuable expertise that we must maintain in the new commission if we do not now get on with the show. The same sentiment was expressed by the National Consumer Council, the Picker Institute and Which? in their letter to noble Lords:
	"It is crucial that the transition towards CQC is well managed and sticks to the agreed timetable. We need to ensure that current good practice around engagement, together with the expertise and skills of the current regulators, is not lost by a prolonged transition process; this would not benefit anyone, least of all those who use health and social care services and carers."
	My noble friend Lord Patel also said that what is crucial now is that the shadow chair,
	"shows some leadership by saying where we are going and how we are going to get there".—[Official Report, 30/4/08; col. GC97.]
	I am delighted that we have been able to secure a first-class shadow chair in the noble Baroness, Lady Young. I am sure she will provide the strong leadership that will ensure that there is a smooth handover next April. Fundamentally, the commission will help deliver safer and better quality care services for people who use them. We do not want to have to say to those same people that it will take the Government another period of delay and uncertainty to get to this point.
	The regulatory framework that has enjoyed such excellent scrutiny in your Lordships' House will support the kind of integrated, personalised services that we all want to see continue to develop, and I want to encourage that in my next-stage review. The noble Baroness, Lady Howarth, has pointed out that some were inclined to support delay, not because they opposed the principle but because they felt that the timing was wrong or that the Bill as drafted would not give the new regulator the best possible starting point, particularly in relation to social care. We have listened to those concerns and brought forward many changes and amendments to the Bill: to introduce clearer objectives, to give the commission an explicit duty to involve and engage with service users and to give it the freedom to determine when and how it conducts reviews of services. I am delighted that the three current commissions have each welcomed those government amendments. We will explore these issues in more detail later on, but they should help reassure noble Lords that the framework is now in place to allow the establishment of the regulator to proceed.
	There is no good reason to reconsider the case for the integration of health and social care regulation and the creation of the Care Quality Commission. Nor is there a case for subjecting the establishment of the commission to any further delay. I am therefore grateful to the noble Lord, Lord Lipsey, for highlighting that he will withdraw his amendment.

Lord Lipsey: My Lords, I do not intend to prolong much more the last rites of this dead parrot save to make a couple of points in response to the debate. The noble Lord, Lord Harris, my old chum and sparring partner, accused me of choosing the weakest of the arguments that had been put forward against my amendment. If those are the weakest arguments, I would be grateful if he would explain to me after this debate why Ministers chose them and not other arguments that might have been more convincing.
	I am not sure that I agree with my previous noble friend Lady Wall that patients worry day and night about whether the new commission to look after their care will be established. They are worried, as am I, about what will happen to them, and that is why I have brought the matter before us.
	In the period up to next April and beyond, when the commissioners and their staff are worrying about the colour of everybody's carpets and the size of their desks, who will be in charge and who will tell whom what to do? I am worried that, during that period, the progress that we have genuinely made in regulation in this field will come to a halt. Most particularly—this will be partly on my conscience because I feel guilty that I did not pick up this problem earlier and try to raise these issues when first the Government proposed this solution—I worry terribly that there will be some dreadful scandal and that infections in hospitals will again get out of control as today's report from the Healthcare Commission warns, or that some old person's home might not receive a visit from an inspector because his or her superior was so busy dealing with the amalgamation that they did not have the time to organise the inspectorate and that, in consequence, all the residents died. That would be on my conscience as it would be on that of all noble Lords who have chosen not to support the amendment today.
	I take comfort from the many amendments that the Government have made to the Bill, all of which I regard as positive and helpful. I do not think that anybody who runs the commission could be unaware now of the danger of it becoming unbalanced as between the priority it gives to healthcare and that which it gives to social care. Knowing the noble Baroness, Lady Young of Old Scone, as I do, I am sure that she has taken that on board. Other amendments before us today may assist in this.
	This will be no prolonged funeral, although I feel some regret and offer a heartfelt prayer that everything that I and other noble Lords have said during the passage of the Bill turns out to be utterly wrong and that the new commission is a fantastic success. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.
	Schedule 1 [The Care Quality Commission]:

Earl Howe: moved Amendment No. 2:
	Schedule 1, page 113, line 7, at end insert—
	"( ) The making of appointments under sub-paragraph (1)(b), and the exercise of the power to make regulations in sub-paragraph (3), must ensure that the functions of the Commission relating to—
	(a) review, assessment and investigation of each kind under sections 42 and 44, and(b) the Mental Health Act 1983 (c. 20),
	are represented in such manner and by such proportion of the members as the Secretary of State considers appropriate."

Earl Howe: My Lords, I shall speak also to Amendments Nos. 5 and 6. I return to a concern which we debated at considerable length in Grand Committee without reaching a conclusion. It is how we can make sure that the three principal spheres in which the new commission will operate—healthcare, social care and the operation of the Mental Health Act—will each receive a fair and appropriate amount of the commission's time and resources, and that the culture and ways of working which characterise those three different spheres of regulation will be respected and promoted. I confess freely that this is a very difficult aim to try to pin down in an amendment, but I am equally clear that the difficulty of arriving at an adequate form of words should not be an excuse for our doing nothing. It is an extremely important issue.
	I have been heartened, as I knew I would be, by everything that the noble Baroness, Lady Young of Old Scone, has said and done since the announcement of her appointment as shadow chair of the commission. She circulated a letter to Peers a few days ago, in which she gave some very helpful reassurances. However, for the purposes of today's debate, we need to remember that the noble Baroness will not be chair for ever, and that we are legislating for the statute book. Therefore, we need to put some safeguards in place that will stand the test of time.
	One of the reasons why formulating an amendment is so difficult is that while in our own minds we may conveniently separate health, social care and the operation of the Mental Health Act as discrete activities, we also know that one of the benefits of the new commission, if it works as we all hope it will, is that it will look more holistically at the way in which care is delivered in a given setting, and that its working methods will reflect and take account of the increasing convergence of health and social care and the crossovers that already exist between all three areas of care.
	We have all acknowledged that while there are key differences between, for example, monitoring the welfare and rights of a detained mentally ill patient and assessing the welfare of residents in a care home, there are almost certainly ways in which each of those two kinds of regulatory activity is able to learn and gain from the other. The same applies to the regulation of healthcare as compared with that of social care. It would therefore be wrong to suggest that we want to preserve in aspic the methodology and culture of each of these forms of regulation, and that we somehow need to insulate them from change. Rather, we need to ensure that there are people on the commission and on its committees and sub-committees who have knowledge and experience of each field, who will take forward the development of regulation in those areas, and who will act as a defence against any potential erosion of the weight and emphasis that needs to be maintained on each principal sphere of activity.
	We want to make sure in particular that the resources needed to deliver the effective regulation of social care and the activities currently undertaken by the Mental Health Act Commission should comprise an appropriate slice of the commission's budget and manpower, and that neither of those activity streams will be at risk of becoming the poor relation of healthcare regulation. The undue ascendancy of healthcare regulation, despite everyone's best intentions, has to be a risk over the longer term.
	The approach I have taken in these amendments is twofold. First, there should be a duty on the Secretary of State in making appointments to the membership of the commission to ensure a fair balance of disciplines in direct alignment with the commission's key regulatory functions. Secondly, I suggest, without going quite as far as the noble Lord, Lord Lipsey, in his Amendment No. 8, that we can require the commission to take into account when establishing committees or sub-committees that the individuality of each kind of regulatory activity should be appropriately reflected in the overall way in which the commission operates. I say with great respect to the noble Baroness, Lady Howarth, that I do not think we need to be prescriptive beyond that rather generalised level. If the Minister were to accept Amendment No. 3, or something like it, I would support her very readily, but my problem with that amendment is that it singles out social care to the exclusion of the other spheres of activity and would tie down the commission to appointing one person, and one person only, as the "commissioner for social care". For the reasons I have given, I feel instinctively that we should try to preserve flexibility in the make-up of the membership and that the balance of disciplines is what really matters. I shall, however, listen with attention to what she has to say.
	I hope that the Minister will look constructively at these amendments and that she will understand that they are a genuine attempt to build in safeguards that will not prove to be an albatross around the commission's neck over the longer term. The wording may not be right—it almost certainly is not—but I hope that it will provide a basis on which the thinking on this important issue can be taken forward. I beg to move.

Baroness Cumberlege: My Lords, I have added my name to the first of these amendments, which is of a slightly different order from the other more prescriptive amendments in the group.
	I think it right that not only the Secretary of State but future Secretaries of State should be reminded of the three different spheres, as described by my noble friend. In his customary way he has fashioned an amendment which would sit very comfortably in the Bill as it proposes using review, assessment, investigations and the Mental Health Act as prompts when appointing to the commission people with knowledge and experience in the three component parts that will form this new body.
	I agree with the noble Lord, Lord Warner, who stated on the previous amendment that parliamentarians are not appropriate people to micro-manage. Throughout the Bill's passage I have tried to ensure the independence of the Care Quality Commission and that it has as much room to manoeuvre as possible. I share the view of other noble Lords that we have an experienced and formidable shadow chair appointed, which I welcome. I thank her for her letter of 12 June in which she let Members of this House know the way in which she plans to recruit members of the commission. She has clearly taken on board the views expressed by your Lordships in Grand Committee and will relay them to the Appointments Commission. So far, so good, but, of course, memories fade and Secretaries of State and chairs of commissions move on. It is tempting to try to secure the future with prescription but I do not think that is right, especially when it comes to management structures. We do not know what the future holds and so often Parliament lags behind trends. We are in a situation of catch-up.
	We are already seeing a coalescence of health, both mental and physical, with social care. We are seeing joint chief executive appointments covering health and social care, new professions emerging, patient pathways being more clearly defined and modern technology encouraging very different ways of working both clinically and managerially. Increasingly, healthcare will not be provided in institutions but at home. Individual purchasers will commission healthcare and social care and definitions will change. Therefore, I am very reluctant to enshrine a management model, a straitjacket within which the CQC will have to work. Management should be dynamic, should reflect changing social and economic trends and encourage vision within the organisation. It should not constrain but liberate. Above all, it should be designed to do the business efficiently and with care and not be encumbered with an outdated management structure enshrined in law.
	So, reluctantly, I do not support the more prescriptive amendments but think that the first one would act as a useful prompt to ensure that the Secretary of State is reminded of the comprehensive remit and duties of the CQC when recruiting members.

Baroness Howarth of Breckland: My Lords, I shall speak to Amendments Nos. 3 and 4. One of the skills one learns in social care is group work. Those of us who have worked fairly closely together in the group that has taken this Bill forward have thought through these arguments time and again, and we have been considerably influenced towards the picture that we now see of how social care is moving forward.
	I want to remind your Lordships forcefully that this is not where we started, and not where the outside world is in its view of the comparative positions of social care and health. We have had reassurances in this House, and I think that we have convinced ourselves that the Bill could give proper emphasis to all the parts. In matters of social care I usually include mental health because my own training included it. That is another issue that I am bound into and it is in close alignment with health and hospitals—the links are all there together.
	I agree with Members on the opposite side—I say that because of the geography, not because of anything political, she says anxiously—that we have to move forward in different ways. I say that in order to emphasise that outside the walls of this now comfortable group which has come through to this position there is still a great deal of anxiety about where mental health and social care will reside in future. I take heart from the assurances of the noble Baroness, Lady Young of Scone, who has impressed even me by her strength of leadership already in how she has moved all these issues forward. I can hope only that this will continue.
	However, there are other reasons for being absolutely clear about what prescription might be. The amendment moved by the noble Earl is prescriptive, if not tightly so. We are in the position of decisions being made—or rather, remade or even re-remade when you think how often social care has been discussed in the past five years. It is crucial that we get it right this time, and that having done so, we will not have to be concerned with the issues of disruption outlined by the noble Lord, Lord Harris. Continuity of service and personnel is what really counts in patient-client-people care, but there has been disruption in recent years.
	I am proposing a dedicated social care commissioner in the amendment, but if I am honest I am not really convinced by my own arguments. As I said in an e-mail to the noble Earl, it is important to reinforce our view. I wish that I had been able to support the noble Lord, Lord Lipsey, earlier. I have been so influenced by the group work in this discussion that we find ourselves at a different place. That is probably what the noble Lord, Lord Warner, was trying to convince us of in his speech.
	I repeat in all seriousness that we are in a different place, which has to be maintained in the outside world. I have only this week been involved in discussions about the place of social care and nursing services for the elderly, and the worry in some places that nursing homes are becoming more nursing than homes. I know that old people are becoming frailer but they are losing that home environment in their need for medical care as they become increasingly more frail.
	These are the kind of things that I want us to maintain. That is why it is vital that on the commission there are people who understand that and who have lived through and have the experiences of some of the people on the ground, who, when you visit and talk to them, tell you time after time that they want personal, human care, not a medical centre. That is the crucial difference between these services. Social care is about individualised, often very long-term care, often at home. Medical care may be long term, but usually it is a short experience in hospital or with your doctor. They are crucially different elements. They overlap in places but people need to understand both. I certainly would not say that there should not be someone from healthcare on the commission, but there must someone from social care because it shows where the danger is.
	On the issue of human rights in Amendment No. 4, it would be useful if a member of staff was appointed to the new commission to fill the statutory position of human rights director. As is the case with social care, the human rights of the people who use social care and health services has been a continuing issue in our debates on this Bill. Having one senior officer specified in the Bill would give that person real authority within the commission to advise it at a senior level on its responsibilities in relation to human rights. This is an amendment I really believe in. It would also act as a strong reassurance for the new commission to place human rights at the centre of its work and activities. The argument against this proposal is simply put. It would be too great an interference with the structure of the new commission to set down specific provisions in the Bill and the commission would be able to get on with its job without interference from Parliament. Once again this proposal has a clear, recent legislative precedent. The Commission for Social Care Inspection, before its responsibilities for children's social care were taken up by Ofsted, had the statutory position of children's rights director set out in the Bill. Drawing from that experience, Dame Denise Platt has said that having an officer whose existence was established by Parliament gave that person real clout within CSCI in keeping children's rights issues at the fore of its policies.
	On wider human rights issues, it is pleasing that during the passage of the Bill the Government have brought forward amendments partially to close the human rights loophole in relation to publicly funded residents in private and voluntary sector care homes. This group of residents will now have the protection of the Human Rights Act, which is most welcome. But that still leaves the group of self-funders, as we mentioned in Committee.

The Earl of Onslow: My Lords, I am pretty certain that the YL case conundrum has not yet been sorted out. This is a problem both for this Bill and the Bill that is being debated in the Moses Room at the moment. It is a very deep and worrying problem which has not been sorted out. The Government have said that they are going to try to sort it out but they have not done so yet.

Baroness Howarth of Breckland: My Lords, I am most grateful to the noble Earl, who reinforces my argument for someone in the commission to look after human rights. This would be only one part of the role envisaged for the human rights director. That role would also encompass mainstreaming, the rights of detained patients and others deprived of their liberty under the Mental Health Act. There will be many issues in relation to human rights within the health sector more generally on which this officer could advise the commission at the highest level and ensure that the information was accurate at every moment. Having the post designated in the Bill would give such a person strong and clear authority.
	We have another precedent in relation to human rights. During the passage of the Human Rights Act, a position was established which is held by my noble friend Lady Campbell in the Human Rights Commission. So I think there are precedents for this kind of measure. It would be wrong to bind the new commission and its management excessively in the Bill, as has been outlined, but the measure clearly has a precedent in the old commission and I hope that the House will support that position.

Lord Ramsbotham: My Lords, I support the amendments that my noble friend Lady Howarth supports and the amendment that she is not sure whether she still supports. I support Amendment No. 3 because, while I absolutely agree with the noble Lord, Lord Warner, that legislation should be about "what", not "how", in this case there is a slightly lateral reason for supporting the idea that there should be a commissioner for social services on the commission. I have already mentioned the problem of children under Ofsted. If such a commissioner had to be on the commission, there would be a jumping-off point for the looking after of children, if that were deemed appropriate, because the commissioner would already be in place and you would not have to start again from scratch or search around within Ofsted.

Lord Lipsey: My Lords, at the risk of appearing to be wimp of the week in your Lordships' House, I prefer Amendment No. 2 in the name of the noble Earl, Lord Howe, and Amendment No. 3 in the name of the noble Baroness, Lady Howarth, to my Amendment No. 8. They achieve much the same thing without injecting the structural over-rigidity that noble Lords have pointed to. I am not yet totally convinced that we have the best solution, as opposed to a better solution. Perhaps I may address the Minister specifically: given that we are now very much on consensus grounds, might it not be appropriate for the noble Earl to sit down with the noble Baroness, Lady Young, and those of us who have expressed a particular interest in this , including the noble Baroness, Lady Barker, to see whether we can find an even better solution to the problem at which these amendments are aimed and introduce it at Third Reading to enable the Bill to go through with a wider consensus than seemed likely at one stage—although it is up to the noble Earl as to whether he presses the amendment to a Division?

Baroness Murphy: My Lords, I am sure that the Minister will realise that we are all after the right consolation prize. I very much agree with what my noble friend Lady Howarth said. We have worked through this as a team, we are where we are, but we all had a great sympathy with where the noble Lord, Lord Lipsey, started from. Now we are trying to see whether in Amendment No. 2 we can at least get some balance of focus among the members of the commission who discharge its functions and make a variety of other stronger changes in the amendment of my noble friend Lady Howarth. Amendment No. 2 is the practical one, in my view, and I share the view of the noble Lord, Lord Lipsey, that we should at this point try to seek some consensus that we can agree to bring back, to reflect our continuing anxieties about the focus of the commission.

Lord Walton of Detchant: My Lords, my intervention will be extremely brief and I cannot but say somewhat wryly that in 19 years in this House I have learnt conclusively that one can never predict with any degree of confidence that entries in one's diary will be fulfilled when interesting developments, such as the intervention of Statements of various kinds, almost inevitably disrupt the timetable on which one would hope that the issues that one wished to speak about could be resolved.
	However, I have great sympathy with Amendment No. 2, ably moved by the noble Earl, Lord Howe, and supported by others. I confess that when the Bill was first drafted, I, like many others, including the noble Lord, Lord Lipsey, and my noble friend Lord Ramsbotham, felt grave concerns about the merger of these very important bodies, each of which seemed to have clear-cut and distinct functions. The more I have listened—from time to time I have been concerned with the discussions in Grand Committee—the more I have recognised that there is a very substantial virtue in the merger of these bodies. In any event, this is now water under the bridge. Initially, I felt strongly in favour of Amendment No. 8, put forward by the noble Lord, Lord Lipsey. If this merged body is to function effectively, it might be necessary to have three separate commissions. But that is contrary to the whole ethos of the Bill. Integration is crucial for this whole issue; that is, a closer degree of understanding and mutual interest between those concerned with the regulation of health, those concerned with the regulation of social affairs and those concerned with mental health.
	Many years ago, I chaired the Nuffield Provincial Hospitals Trust meetings on communication between doctors in various branches of medicine, and also on communication between doctors and members of other professions, and one comment has stuck in my memory. It was of a social worker speaking to a doctor, who said, "I can't hear what you are saying when what you are rings so loudly in my ears". Such a lack of mutual understanding quite often prejudiced the collaboration between doctors and social workers. The situation has vastly improved.
	The crucial aspect of this Bill, which is enshrined in Amendment No. 2, is that within this commission there should be individuals who are experienced in and knowledgeable about health, social care and social matters and, also, those who have got experience in mental health. The membership must reflect that kind of interest. If that is achieved, it is likely that the integration will result in a much closer degree of collaboration and mutual understanding between the various branches of work to which I have referred. For that reason, I strongly support the principle outlined in the amendment tabled by the noble Earl, Lord Howe, and others. The crucial thing is that that kind of membership will be achieved within this commission in order to develop the integration which everyone wishes to see.

Baroness Meacher: My Lords, I, too, support Amendments Nos. 2, 5 and 6, to which I added my name. The noble Earl, Lord Howe, clearly articulated the arguments for these amendments. I want to put on record my reasons for having shifted my position since we last debated these issues. In Committee, I pressed for a mental health sub-committee to try to make absolutely sure that the role of the Mental Health Act Commission in relation to detained patients was not lost. Others argued for a social care sub-committee or for specific work strands to be represented on the commission itself.
	I would like to thank Ministers for our very helpful discussion since the Committee stage on this issue and many others. They are clearly well aware of the concerns, in this House and elsewhere, about the potential for acute health services to dominate the CQC, if only because those services have such enormous public interest and also considerable problems, as we know well.
	I have become conscious of the need for flexibility within the CQC as, over time, services within the country and the role of the CQC evolve. Even at this stage, the remit of the CQC to regulate services delivered to individuals and small groups and to hospitals and large organisations may require an organisational structure that will not, in fact, fall neatly into health, social care and mental health. For example, taking one possible scenario to illustrate a point, one could envisage a structure with five work strands: individual rights, hospital services, community homes, commissioning, raised by the noble Lord, Lord Warner, and perhaps prison health services. In such a structure the individual rights strand could cover detained patients in psychiatric units, but also individuals whose rights are protected by the Mental Capacity Act, very much in the social care field. However, they have problems very similar to those of detained patients—they are, de facto, detained and they are often given medication without informed consent either because they are not capable of giving that consent or because they are alleged not to be capable. Another group of people who might be covered in that single strand of individual rights could be, for example, people on community treatment orders who have not been covered by the Mental Health Act Commission because those orders do not come into effect until the autumn of this year. Things are changing year by year.
	I hope that I have said sufficient to explain why I have come to the conclusion that the one thing we must not do in this House at this time—we are not capable of doing it—is to try to be specific about the structure of the commission and sub-committees on the CQC. I therefore strongly support Amendments Nos. 2, 5 and 6. Those amendments take account of that flexibility—it is vital flexibility. I would be concerned about having another jig at this because the incentive for a number of noble Lords is to try to be more specific. That would be unhelpful and would not be in the best interests of patients and service users in future.

Baroness Barker: My Lords, my name is not added to any of these amendments. The reason for that is that I do not want a consolation prize. I am clear about what I want: a commission whose objectives are sufficiently clearly set out that its purpose is unmistakable and one which involves the right people making those objectives become a reality. I do not underestimate the difficulty of what is being attempted here. I hesitate to say this in front of the right reverend Prelates but—this follows on from the comments of the noble Lord, Lord Walton of Detchant—someone once said to me that trying to get health and social care groups to talk to each other in a meaningful way was like trying to get one bunch of people who believed that health professionals are gods to speak to another bunch of people, social workers, who have strong doubts about the existence of god but who are absolutely certain that, whatever else he is, he is not a health professional.
	The standing of any regulator depends on the way in which it is set up—the objectives that are given to it and, often, the strength of the personalities and depth of experience of the people who go along to it. One problem is that we do not know who will be involved at any one time; we could have someone who was extremely forceful and knowledgeable about mental health, which might make us feel differently about the rest of the composition. We also need a body that is sufficiently resilient to be able to advise government when their policy is wrong and withstand the pressure that can fall on regulators when scandals happen. Scandals are one of the main drivers of policy, particularly in health and social care. We need a strong body that can ride out the storm of a scandal and keep true to its strategic objective.
	I am not convinced that we have got an answer but I am convinced that we need to set out in statute the composition of the commission. That is why I would like the opportunity, between now and Report, to find out from the existing commissioners what, in their experience, has enabled them to do their jobs as well as they have done. In particular, I wish to find out from them what enabled them to be proactive and what made them sit up and think afresh. Has it been coming into direct contact with users; has it been doing long-term work with subgroups of people; or has it been the dynamic process of bringing different people together and moving them forward?
	I want to end up with something like Amendment No. 2, which will mean that at any point when a strategic or major decision is made there is somebody who comes from a background sufficiently different from everybody else in the room who has the power to say, "No, what you are doing is wrong. Think again".
	However, I should still wish for the opportunity to talk to Ministers and the existing commissioner to make sure that finally, we get this right.

The Earl of Listowel: My Lords, I support Amendment No. 2 and what my noble friend Lady Howarth of Breckland said regarding the special nature of personal human relationships in terms of social care. There is concern that culturally, as a nation, we have so far undervalued and misunderstood the nature of that special relationship that we need to be very careful as that that status is not in any way undermined. I was not a part of the group working through the Bill in Committee, for which I apologise, and I know that these thoughts were well represented.
	Although I know that we are dealing with adults here, perhaps I may refer to the experience of children. I was at a meeting earlier today where a foster carer had two 13 year-old foster children with her. She said that when they came into her care they had a 30 per cent attendance rate at school; currently in her care, they both have a 100 per cent attendance rate and are doing very well in their studies—one wishes to go on to university. But in three years' time, at the age of 16, they may have to move on from her care. Some 25 per cent of young people in care leave at the age of 16. I know that the Government are taking admirable steps to address this, but it will be a very long process.
	If one compares what happens on the Continent—in Denmark, for instance—where a young person can be looked after in the same placement until their late 20s if they wish to, one sees that we have not recognised that enduring, long-term relationships can be so important in achieving what we wish. These children bear the cost of these long-term relationships not being valued by entering the criminal justice system and failing in various other ways; the adult population bear the cost of having to care for them in hospital when they might have been cared for at home if the necessary priority had been given. I am very worried about the status of those front-line people delivering the relationships which enable social care to function. There needs to be a recognition of the cost involved and that the best input into these carers is needed—foster carers in this case, and adult carers of other kinds.
	I look forward to hearing reassurance from the Minister, which I am sure will be forthcoming. I also see that the new leader of the commission is here, so this is an opportunity to raise these issues with her.

Lord Low of Dalston: My Lords, I was going to support Amendment No. 8, tabled by the noble Lord, Lord Lipsey. I do not see that the demands of integration, which are a real potential strength of the commission, are incompatible with the need for specialisation. Indeed, no cake is indivisible; it has to be split up in some way or another. The main board of the commission will probably need specialist advice on issues dealing with health, social care and mental health. It is the role of the main board of the commission to bring those streams together in an integrated way and achieve cross-fertilisation.
	My position has moved somewhat, as has that of other noble Lords, as the debate has gone along. Indeed, it has moved further in the course of this debate, as I shall indicate in a moment.
	As discussions have taken place between Committee and today, I have been keen to see that we are not too prescriptive about what we put in the Bill and that we leave the new commission room to make sufficiently flexible arrangements as to its structure so that they can be changed over time to meet changing circumstances. That does not absolutely preclude putting something definite, such as specialist committees, in the Bill. For example, the Commission for Equality and Human Rights, which is often referred to in this context, has a disability committee which has been established for five years and the question of whether it should continue at the end of that period will be subject to review. We could do something like that in this Bill. However, I am persuaded that we should not do anything too prescriptive, and perhaps Amendment No. 2 will achieve that.
	I think—I should be glad if the noble Earl, Lord Howe, would confirm this—that Amendments Nos. 2, 5 and 6 hang together, so I would not want Amendment No. 2 to be agreed to without Amendments Nos. 5 and 6. They refer to slightly different things and stand together as a package. However, what has most decisively caused me to shift my position further today is the fact that the noble Lord, Lord Lipsey, no longer wishes to press his Amendment No. 8. Indeed, he pre-emptively withdrew it even more forcefully than he withdrew Amendment No. 1.

Lord Lipsey: My Lords, I have not withdrawn my amendment. I said that I preferred others and that if another—or the process for finding an even better one—were accepted by the Minister, I would then be minded to do so.

Lord Low of Dalston: My Lords, I apologise to the noble Lord for reading too much into what he said but I am very happy to align my position with his. If the Government could come up with a formula that took account of the need to recognise the respective fields of health, social care and mental health in the commission's structure—indeed, if they are not able to come up with a formula today but would, as the noble Lord suggested, have further discussions with interested Peers with a view to getting the right form of words on which we could all move forward together—I should be very happy to support that position.

Baroness Howe of Idlicote: My Lords, I apologise for not taking a very large part in this debate but, as your Lordships know, a lot of competing Bills have been going through the House simultaneously and my time has been taken up with the Criminal Justice and Immigration Bill. However, things have clearly moved on and I have very much kept in touch with what has been said. I had enormous concerns at the beginning, very much along the lines of those of other people who have spoken today, but I have been impressed by the extent to which everyone has been persuaded along this road. I should make it clear that this approach of amalgamating a number of bodies—what I call the "Lord Carter of Coles process"—has been going on throughout my time in your Lordships' House in a number of areas, including legal services, equality, the criminal justice system and communications, with Ofcom; this is another one.
	I should have been very much in favour of a number, if not all, of these amendments—in particular, I should have liked to support the suggestions put forward by my noble friend Lady Howarth—but if you are setting up this sort of commission and inspectorate, is it really sensible to give one group special attention over and above the others, as we have heard already with regard to the disability group? There is bound to be a feeling of inequality.
	What I have picked up, as has everyone else, is that we need to ask the Government to think through something that will meet those needs, because the provision is clearly not yet perfect. It is important that human rights are made explicit in the Bill. I very much like the phrase used by my noble friend Lady Howarth: the problem with nursing homes is that they have nursing but alas, in many cases, are no longer seen as homes for the elderly and those requiring full-time care. They do not get as much attention as they would if they were in their own homes.
	We are down this road. The Government are determined to get all these groups to work together. They have been planning it in all the different areas that I mentioned ever since I came into your Lordships' House. That is their pattern. We have gone along with it to a certain extent and in some cases have approved the path that we are on. I have and will continue to have my reservations about what has been done, but we are where we are, as has been said by others, so I support the amendment.

Lord Darzi of Denham: My Lords, I recognise the need for the right competencies and expertise in particular areas of the commission's work. I also understand and support the intentions behind most of the amendments.
	As has been pointed out, last week the shadow chair of the Care Quality Commission—the noble Baroness, Lady Young—wrote to Peers signalling her commitment, working with the Appointments Commission, to ensure that the collective skills, expertise and background experience of the commission's membership reflects the importance of mental health and social care as well as health and other users' interests.
	As the noble Lord, Lord Walton, pointed out, our purpose here is to achieve the right competencies to achieve the right integration. However, the amendments in this group reflect different approaches to ensuring that the Bill reflects that crucial aim.
	I have some sympathy with Amendments Nos. 2, 5 and 6, proposed by the noble Earl, Lord Howe, and supported by the noble Baronesses, Lady Cumberlege, Lady Murphy and Lady Meacher. They propose flexible mechanisms which seek to ensure that the commission's chair, members, committees and sub-committees collectively represent the range of the commission's statutory functions. I will have to reflect on whether the noble Earl's approach, which focuses on the commission's vital role in monitoring the use of powers under the Mental Health Act and its review functions specifically under Clauses 42 and 44, really delivers the desired result. However, I applaud his ambition to secure proper representation while maintaining flexibility for the commission itself to decide how best to deliver its statutory functions. I am delighted to have heard that in recent days many noble Lords have acknowledged that it is vital for the commission to maintain that flexibility.
	I appreciate the intention behind the alternative model proposed by the noble Baroness, Lady Howarth, in her Amendments Nos. 3 and 4, which is to ensure that social care and human rights are properly represented within the commission's governance. However, I am not sure that the proposed mechanism to achieve that end is through legislation requiring specific posts. Also, although I agree with the intentions of the noble Lord, Lord Lipsey, in his Amendment No. 8, I do not feel that the right way is to create separate sub-commissions to achieve that purpose, each representing one of the current three commissions.
	There is no doubt that the new commission will build on the expertise of the three existing commissions, while maximising the advantages of integrated regulation. As we said in Grand Committee, we envisage that much of the expertise will transfer from the current commissions.
	However, rather than creating silos—which we are trying to break here—in the shape of the sub-commissions that the noble Lord proposes, the new commission needs to take the existing differences into account and build on the best of each of the current commissions to release the potential benefits that we all aspire to achieve; for example, the benefits to the provider of both healthcare and social care services, and the benefits to the user of seamless regulation across their care pathway. Once again, I believe that it must be for the commission to decide how best to structure itself and deliver its functions, be that through sub-committees, specific posts or other mechanisms. After all, we are trying to create an independent regulator—something that I know that noble Lords fully support.
	I remind noble Lords that the Government have sought to reassure all sides through the Bill process that social care and mental health interests will not be lost in the new commission. I hope that the fact that the Commission for Social Care Inspection and the Mental Health Act Commission welcome and support government amendments will provide further reassurance, in particular to the noble Baroness, Lady Howarth, and the noble Lord, Lord Lipsey. There are already further necessary checks on the Care Quality Commission in the Bill. The current drafting explicitly requires that the commission report annually to Parliament and the Government on the provision of adult social care services, on the exercise of its Mental Health Act functions, and on the way in which it has exercised its more general functions.
	Once again, I stress that I have sympathy with noble Lords' efforts to ensure, through various approaches, that the commission's governance structures will reflect the skills, expertise and focus needed to carry out its full range of functions, without the focus of any one of them being at the expense of any other. As I hope I have made clear, while I do not support amendments that would impose inflexibility on the commission in the way that it performs its statutory functions, I support noble Lords' intentions and am happy to reflect on this debate and seek their thoughts further, prior to bringing this back for Third Reading with amendments that will fulfil their aspirations. With that reassurance, I ask noble Lords not to press their respective amendments.

Earl Howe: My Lords, I am grateful to all noble Lords who have taken part in this debate, and particularly to the Minister for his encouraging reply—encouraging in so far as he agreed to reflect on my amendments, from which I take heart, and in his acknowledgement that the issue of the commission's membership is important.
	I believe that all noble Lords—especially perhaps the noble Baroness, Lady Barker, and the noble Lord, Lord Walton—were clear that we need to focus on the composition of the membership. The question is how we achieve precisely what we all want. The noble Baroness, Lady Barker, made the very helpful suggestion that we should talk to existing commissioners to see what has made the difference for them in performing their respective roles.
	As the Minister has said, the challenge is to avoid undue prescriptiveness and to ensure sufficient flexibility in whatever wording we look for. The noble Lord, Lord Low, was absolutely right about that. If the Minister is willing to search for consensus between now and Third Reading, I am more than happy to join him in that endeavour. I am encouraged by the contributions from noble Lords to believe that we have the basis for such a consensus. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.
	[Amendments Nos. 3 to 6 not moved.]

Afghanistan

Baroness Taylor of Bolton: My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Defence Secretary. The Statement is as follows:
	"Last December, my right honourable friend the Prime Minister set out a clear and long-term framework for bringing security and political, social and economic development to Afghanistan.I should like to give the House an update on some of the progress that we have made since then in Afghanistan, based on my most recent visit to Afghanistan last month, and to set out our future plans for the UK's military contribution to the NATO-led International Security Assistance Force, ISAF.
	"The security situation in Afghanistan has improved in the past 12 months. The Taliban's leadership has been targeted successfully and recent operations in southern Helmand have disrupted severely its training and lines of communication. This has had two principal effects. First, its sphere of influence has been reduced. Nine-tenths of the security incidents are confined to one-tenth of the country. The rest is relatively peaceful. Secondly, we have seen the Taliban reduce its ambition from insurgency to terrorism. Its campaign is now limited to intimidating Afghan communities, coercing the vulnerable into becoming suicide bombers, and carrying out brutal and indiscriminate attacks on the international community and, above all, on Afghans themselves—men, women and children. As its conventional attacks have failed, we have seen its tactics shift to mines, roadside bombs and suicide vests. These tactics run deeply counter to the Afghan culture. So does the Taliban's reliance on paid foreign fighters—the so-called "ten dollar Talibs"—who now make up the majority of those doing the fighting for it. I fully recognise that the Taliban's new tactics pose a different but very serious challenge both to our forces and to local people. We need to ensure that we do all we can to mitigate this new danger and I am fully engaged on making sure that we do so.
	"I share the understandable international concern about the break-out from Kandahar prison on Friday 13 June. The Government of Afghanistan are leading the response to this incident and we are monitoring it closely. We have always said that the challenge of supporting an Afghan lead on security goes wider than support to the Afghan armed forces to include the justice sector, and we are already engaged in supporting a programme of justice reform that includes work on prisons. International support to the Afghan Government's security response is being provided through NATO's presence in Kandahar. Let me conclude here by saying that, notwithstanding the extremely serious nature of this incident, it does not change our view that the Taliban is losing the fight in southern Afghanistan.
	"The Afghan people, like people the world over, long for security, stability and prosperity. They understand that the Taliban cannot deliver these things. Our forces, alongside the US, Canadian, Dutch, Australian, Danish and many others, are in Afghanistan to fulfil a UN mandate, to support the elected Government, to train and mentor the Afghan army and police, and to give the Afghan people hope for the future. I believe, as I think does the great majority of this House, that Afghanistan is a noble cause, but we also know that it comes at a tragic human cost, as we have been reminded over the past week. The recent deaths of five members of 2 Para, as well as the 97 other UK fatalities in Afghanistan since 2002 and all those UK personnel who have been wounded or otherwise scarred by this conflict, are an enduring measure of the dangers that our young service men and women face on operations on our behalf.
	"The military knows better than anyone that this is a campaign that cannot be won by military means alone. Once security has improved—and it has—delivering improvements in infrastructure, governance, rule of law, schools, hospitals and services must follow. Generating these in a country devastated by decades of conflict, and the fourth poorest in the world, is difficult and challenging. It will be a long term endeavour, but I saw real progress here during my trip. There is now a tangible sense that life for many Afghans is improving.
	"In Helmand, they have a new and extremely able governor, Governor Mangal, who is spreading the writ of the Government of Afghanistan further into this once lawless province. During the week of my visit, the local people of Garmsir reopened their hospital for the first time in two years. In Lashkar Gah they had also just opened a new high school; some of the girls attending that school will represent the first women in their families ever to go to school and receive an education.
	"We in the UK are not alone in our commitment to Afghanistan. Last week, 80 countries and international organisations met in Paris at the International Conference in Support of Afghanistan. In Paris, the Afghan Government's national development strategy was launched. This plan provides an Afghan blueprint for the future development of their country. Last week in Paris the international community pledged $20.4 billion to help fund it, and reaffirmed its support for Kai Eide in his role in co-ordinating efforts to help deliver it. I do not underestimate how much remains to be done, but the green shoots of development and democracy are becoming ever more firmly rooted in a security environment that has improved out of all measure since UK forces deployed to southern Afghanistan two years ago.
	"This focus on development does not mean that we are complacent about security; far from it. As I said before, the shift in tactics—while being, in one sense, a sign of strategic weakness—presents us with a different but still serious challenge, one which our forces are confronting with the same courage, professionalism and intelligence that they have shown throughout the campaign. At the same time, the Prime Minister's December Statement made clear that, over time, we plan to rebalance our military commitment, from one based on direct combat operations, to one of support for the Afghans' own security forces. There is some good news here: the Afghan National Army is a success story. Afghan soldiers are fearless and redoubtable fighters, and the ANA is respected and admired by the Afghan people. Their professional competence is also increasing by the day. The first ANA Kandak, or battalion, has now reached Capability Milestone 1, which means that it is capable of fully independent operations. Our soldiers are finding that the level of mentoring required by the Afghan National Army has markedly reduced as their capability and experience grows. This is no mean achievement.
	"Creating an effective police force is proving to be a more difficult challenge. To accelerate this process, the coalition has introduced a process called focused district development, which is, in effect, a mass training and retraining of the Afghan national police, district by district. This ambitious plan has an annual budget of $2 billion per year and is making a big difference, but we have to accept that creating an independent, effective police force in Afghanistan will not happen overnight.
	"Counterinsurgency campaigns are ultimately about winning the support of the local population. With the diminishing relevance of the Taliban's campaign and the increasing delivery of development, I am in little doubt that we are winning. In this context I have decided, with the military advice of the Chiefs of Staff, to make a number of adjustments to the profile of our forces in Afghanistan. Currently we have 7,800 troops in Afghanistan, deployed to Helmand, Kandahar and Kabul. As a result of a recent review, I have approved the removal of around 400 posts from the Afghan operational establishment. These posts are no longer required due to reorganisation and the changed nature of the tactical situation. At the same time we have identified a requirement for, in total, 630 new posts, creating a net increase in our forces in Afghanistan of some 230 personnel to around 8,030 by spring 2009.
	"Broadly these adjustments have three aims: first, to improve the level of protection afforded to our personnel; secondly, to increase the capacity of our forces to deliver training and mentoring to the Afghan national security forces; and, thirdly, to increase the capacity of our forces to deliver the civil effects of reconstruction and development in an insecure or semi-secure environment. All of these aims are vital if we are to sustain the progress that we are making.
	"Let me set out the nature of these changes. The first objective of these force adjustments is to increase the protection that we are able to give our brave service men and women as they conduct their mission in Afghanistan. In the months ahead we will deploy more troops to man the additional Viking and Mastiff vehicles that we have already ordered. Further specialists will deploy to man reconnaissance and warning systems in our forward operating bases across Helmand. We will also reinforce the Royal Air Force Regiment squadron that helps defend Kandahar airfield. The House will recall that improvements that we have made to ground support and crewing arrangements for our CH-47 Chinook and AH-64 Apache helicopters have increased the total amount of flying time per month available to our commanders in Afghanistan. Part of this uplift will be delivered by an increase in helicopter crews which I am announcing today.
	"Among the most potent of all our capabilities in deterring and denying the insurgency is our ability to project close air support. In Afghanistan we have a contingent of Harrier GR-7s and GR-9s that have proven time and again their value in defending the lives of our troops, our allies and those they are there to protect. The Harrier force, first deployed to Kandahar airfield in November 2004, continuously has been in operation ever since. This is an impressive record by any standards but I am very mindful of the strain that this extended deployment has put on the crews, their families and the wider roles of Joint Force Harrier. I have therefore decided to withdraw the Harrier force by spring 2009 and to replace it with an equivalent force of Tornado GR-4s.
	"I have already mentioned that by developing the Afghan security forces we are setting the conditions to allow them to take an increased role in their own security. To accelerate this we will expand our fourth Operational Mentor and Liaison Team to accelerate the development of the Afghan National Army and we will continue to train the Afghan national police. In particular, we will focus our efforts to help Afghan National Army and police commanders to develop the skills they need to lead their forces effectively in a demanding and often very dangerous area.
	"The improved security situation that our forces are generating has provided us with a real opportunity to increase the rate of our delivery of civil effect. I have therefore decided that when 3 Commando Brigade deploys to Afghanistan this October, it will deploy with an additional infantry battalion headquarters and sub-unit. These forces will operate in southern Helmand to ensure that we are able to consolidate and exploit the security gains that we have made in that area. Three Commando Brigade will also deploy with an extra troop of Royal Engineers to support our provincial reconstruction team by undertaking quick impact projects in support of the local community. These forces will be supported by more medical, logistical and equipment support troops.
	"In addition, we will attach civil/military co-operation officers to each of our battlegroups and we will form military stabilisation teams on the model of the ad hoc team that we deployed with great success in the wake of the reoccupation of Musa Qala. Both of these measures will enable us to take forward development projects, including quick-impact projects in areas where the level of threat remains high.
	"My announcement today of a net uplift of 230 additional troops does not in proportionate terms represent a very significant increase. It does not mean our mission is expanding. It means we are taking the steps necessary to take our mission forward as effectively as we can, with a force whose profile and capabilities are optimised to the conditions that they face. As I have explained, the uplift and rebalancing will enable our forces to strengthen their protection and to increase the rate at which they are able to build Afghan capacity in security, governance and development. Some of these new capabilities will need a year before they are available for operations in Afghanistan. Others will deploy much sooner. And, of course, we shall continue to work to develop the optimum balance of forces and capabilities, in conjunction with the Afghan Government and our allies, in what can be rapidly changing conditions. These additional forces will ensure we can maintain the growing reach of the Afghan Government in Helmand, increase the military contribution to development and accelerate the pace of Afghanisation.
	"We talk in this House in terms of numbers, units and strategies. But as the events of the last week have reminded us, behind these numbers are individual young men or women working courageously in strange, difficult and dangerous conditions far from their families back home. Constantly I am impressed by their bravery and resourcefulness, and on behalf of the Government—and, I am sure, the whole House—I express our gratitude for their service to the nation, and commit myself to continuing to do everything we can to support them.
	"Mr Speaker, I commend this Statement to the House".

Lord Astor of Hever: My Lords, I thank the Minister for repeating the Statement. I, too, pay tribute to our Armed Forces. They have performed superbly in Afghanistan. Those who have given their lives there are irreplaceable to their families and friends, and we will remember them in our thoughts and prayers.
	The Minister knows that we on this side of the House wholeheartedly support our troops in what they are doing in Afghanistan. Nevertheless, we feel increasing anxiety about the news coming out of that country, particularly about the shortcomings and questionable attitudes on the part of the Afghans themselves. The terrible corruption in the Afghanistan Government needs to be addressed urgently.
	We welcome the extra troops mentioned in the Statement, particularly the extra helicopter crews and ground support and more troops to man the new Vikings and Mastiffs. We also welcome the extra Royal Engineer troops to help with the vital work of reconstruction. However, former NATO commander General McNeill has said that many more troops are needed to defeat the Taliban-led insurgency. "It's an under-resourced force," he said. Does the Minister believe that the force size is now sufficient?
	We have consistently raised concerns about the force size in Afghanistan. Does today's increase not make a mockery of the Government's national security strategy, published only 12 weeks ago? It says that,
	"we are entering a phase of overall reduced commitments, recuperation of our people, and regrowth and reinvestment in capabilities and training".
	Is it not the case that our forces will be more overstretched, not less?
	The Government must ensure that they provide our dedicated and courageous service men and women with the support and equipment they need to ensure that the sacrifices of the past two years are not in vain. The House will be aware of Brigadier Ed Butler's imminent retirement. He is one of Britain's brightest soldiers and took the opportunity to denounce chronic resource shortages which dogged the battle groups that he once commanded in Kandahar.
	As the Statement pointed out, recent deaths in Afghanistan have shown the Taliban's shift toward suicide bombing as a tactic. We have seen in Iraq what this can mean. Will the Minister give the House an assurance that all necessary protective equipment is available to minimise the risk to our Armed Forces? Will she give an assurance that the Afghan police and military are giving their fullest co-operation in attempting to minimise these threats?
	We are concerned also about the lack of development in Afghanistan. The noble Lord, Lord Ashdown, pointed out that western aid to Afghanistan is one-50th per head of population of the amount spent in Bosnia and Kosovo, and less in terms of resources than has ever been put into a successful post-conflict stabilisation and reconstruction effort. What recent discussions have the Government had with the Pakistan Government about Taliban sanctuaries in Pakistan and the Afghan Government's threats to mount cross-border raids into Pakistan?
	Ignoring Afghanistan or, worse still, abandoning it is not an option. The costs of failure are much too high to contemplate. The Government know that they have our full support in their objectives in Afghanistan, but they need urgently to address the gap between commitments and military capabilities if we are to succeed.

Lord Lee of Trafford: My Lords, I am sure that the thoughts of the whole House will be with the families of the five paratroopers who were killed in Afghanistan last week and whose bodies were brought to RAF Lyneham in Wiltshire today. As has been said, our service personnel are involved in a noble cause and they are fighting with considerable bravery in Afghanistan.
	However, throughout the Statement was a thread of optimism which I question. The rather dismissive phrase "ten dollar Talibs" belies the strength of the Taliban forces, as evidenced by the serious clashes of the past 24 hours. The phrase,
	"the green shoots of development and democracy are becoming ... firmly rooted",
	is a shade dangerous. "Green shoots" is always questionable when used in political terms, particularly in a situation such as Afghanistan.
	Nevertheless, we welcome the net increase in our forces and the redeployment announced today. However, we still have significant forces in Iraq whose military role, whatever their political significance, is at best limited, whereas the need for more forces in Afghanistan is unquestionably desperate. There should be a redeployment sooner rather than later. I would have been much more encouraged today if, parallel to the statement that we were increasing our forces, the Defence Secretary had indicated that he had secured agreement from other NATO forces to put more of their troops into Afghanistan in support of the coalition's efforts.
	I have five questions to put to the Minister, the first of which is on the Kandahar breakout. Are the Karzai Government receptive to advice from the coalition on improving security in the prisons there? Are any of our experts helping the prison authorities? Have any of the prisoners who escaped been caught? Secondly, if a FRES-type vehicle were available, would it be deployed in Afghanistan? Thirdly, on the welcome deployment of the Tornado aircraft, is work being undertaken to modify the Typhoon for future use in Afghanistan? Fourthly—the noble Lord, Lord Astor, referred to this—do the Karzai Government have the support of Her Majesty's Government and the coalition in threatening to send forces over the border into Pakistan if Taliban incursions continue? My final question is on opium, of which there was no mention in the Statement. Is the coalition any nearer to an agreed policy in regard to opium production and/or confiscation?

Baroness Taylor of Bolton: My Lords, I thank both noble Lords for their comments about the work of our Armed Forces. Whatever detailed questions we may wish to pursue about arrangements on the ground or the attitude of the Afghans, the one thing that we can all be proud of is the work our Armed Forces have done—and we should always pay tribute to the sacrifices they have made. I think that that unites everyone.
	Both noble Lords asked a number of questions and I shall try to deal with all of them. There was some crossover between them. I say to the noble Lord, Lord Lee, that a great deal of work has been done on opium and drugs. The production of poppies is often closely related to those areas where the Taliban has a significant degree of control. We have worked with the Afghan Government. We advise them and try to assist them, but they take the lead in what is their domestic problem. We have to increasingly accept that while we can offer advice, give guidance and make suggestions, we are trying to get to the situation where the Afghan Government control Afghanistan. One thing we have to do is to extend their range of governance, because that has been one of the problems.
	The attitude of the Afghans and the situation of corruption, which is often linked to poppy production, concerns everyone. That is one of the reasons we say that our role is not simply military; it is to help the Afghan Government establish the rule of law and a justice system for their transition to a more sustainable democratic country in which people can go about their normal lives with the guarantee of proper justice being administered in that area. There is a long way to go. There is no tradition of a court system that we would recognise. That is one of the problems and one of the reasons why we have put some effort into not only trying to train an Afghan police force but also giving help, advice and training to people who might be judges within that system or work within the court system. It is very complex. The backlog of training and the lack of experience is significant, and something that we have to take on board all the time.
	General McNeill was quoted regarding the need for more troops and the size of the forces that are there. I remind the House that we are in Afghanistan under a United Nations resolution with NATO in the lead. Forty countries are contributing in one way or another. Seventeen ISAF countries are working in the south and the east in difficult circumstances. My right honourable friend the Secretary of State said in another place a short time ago that the attitude within NATO and within our allies generally has been improving.
	At the Riga conference when the ISAF was talking about how many troops could be deployed, the figure was 32,000; at Bucharest it was 47,000. By the time of the Brussels discussions just last week, the figure had grown to 50,000. Therefore, we are seeing significant improvements and more of our allies putting in helicopters or providing support. Although we always want people to do more—I do not think that we should make any bones about that—there is movement in the right direction. Not least for that reason I do not think that our announcement today cuts across the national security strategy about the overall reduced commitments that we will see. They will not be instant but we can see the direction in which we are moving in those areas where we are committed.
	Questions were asked about support and equipment. There have been concerns in the past and things could have been done differently in some areas but we have learnt a great deal given the unique nature of the deployments in which we have been involved. The threat that we are facing changes almost on a monthly basis. Therefore, we have had to adapt. At one time a certain type of body armour might seem to have been adequate but we have learnt how to improve it, and the same is true of vehicles. At certain times certain vehicles are extremely popular because troops feel safe in them, but if the threat changes you have to adjust that situation. We have seen significant improvements in terms of helicopters and the vehicles that have been provided already such as the very successful Mastiff vehicles. Ridgback vehicles will come into operation next year. Personal protection afforded by way of kit has improved significantly. We take all these issues extremely seriously. However, the situation is changing so it will always be a challenge. We will always look to find new ways of keeping one step—or, we hope, slightly more than one step—ahead of the challenges that we face.
	Mention was also made of the amount of aid that is given to Afghanistan and whether the percentage is less than that given to Bosnia and Kosovo. Considerable aid is going into Afghanistan but the basic infrastructure is very limited. We cannot transform an area just by putting more money into it. We must be able to put in sustainable infrastructure and to co-operate with the Afghans as regards what they can absorb. The commitments that were made recently at the Paris conference show that people are willing to provide aid and support to Afghanistan but that must be done in a way that will produce sustainable and lasting benefits.
	The House needs to understand just how difficult it is to patrol the border with Pakistan, which I think is nearly 3,000 kilometres long and comprises some of the most difficult terrain anywhere in the world in terms of altitude and small passes. That is a real difficulty which causes great concern and is a problem on both sides of the border, both for the Pakistanis and the Afghans. Much of what can be done comprises getting better co-operation between those countries, and that is what we have to do.
	The noble Lord, Lord Lee, said that perhaps we were too optimistic because there was a thread of optimism running through the Statement. It is a cautious optimism, but if you look at the security situation now compared with that of a couple of years ago you will see that things have changed considerably, as was said in the Statement: nine-tenths of the incidents occur in one-tenth of the country. Therefore, much of Afghanistan is much more peaceful and much calmer than it was.
	I understand that some escapees from the Kandahar prison break-out have been recaptured but details are very shaky. In terms of whether the Afghans are receptive to advice, I go back to what I said earlier about our willingness to provide advice on the justice system. That includes prisons but again we are building up a system with a different culture for the future than has perhaps existed in the past. We have to be aware of the difficulties that are involved.
	The noble Lord asked whether any FRES-type vehicle would be deployed, were it available in Afghanistan. He should be aware that FRES is a programme for replacing existing vehicles over a number of years with vehicles that will be part of an integrated group, so that they will be compatible and which will have radios and electronic counter measures that do not interfere. It is an important concept for replacing vehicles. On what aircraft will be used, we have no plans to use Typhoon at the moment, although obviously all those things are kept under review.
	We understand that there are issues still to be met, but both noble Lords who have spoken have shown that there is concerted support for the basic activities in which we are engaged in Afghanistan.

Lord Tomlinson: My Lords, will my noble friend accept that I, like every other Member of the House, echo the condolences that she expressed to the five brave young men of 2 Para who died bravely serving our country. They will be long held in our esteem and memory.
	I have a couple of questions on the Statement. First, would it not be of greater assistance if our NATO allies did two things? The first would be to match the sort of expenditure on defence that we and the French are making so that they are in a better position to afford a proper contribution to a mission that they themselves have voted for, and in doing that, it would be helpful if they produced fewer caveats in relation to the deployment of their troops. It is clear that some of the troops of our NATO allies are deployed at less than the optimum if they are deployed in areas in which caveats make them less useful.
	Secondly, I heard my noble friend's answer to the noble Lord, Lord Lee, on the question of the poppy harvest and understand its complexity. But the proportion of the Afghan gross national product that derives from the cultivation of poppies and the illegal production of drugs from them is linked to criminality, as she said, and has a destabilising effect on the redevelopment of Afghanistan. I do not expect her to answer today, but will she undertake to look again at the report of the Senlis Council—a respected international consortium of charities? It examined at some length the process of the drug harvest in Afghanistan and concluded that in circumstances in which there is a global shortage of medical opiates, a useful contribution to the resolution of the drug problem could be the scheme proposed by the Senlis Council for the transfer of those illegal drugs into medical opiates, which would at least have the prospect of providing a realistic income to Afghan farmers who cannot readily replicate the income that they have now with some of the schemes that have been put forward?

Baroness Taylor of Bolton: My Lords, I know that my noble friend has followed with great interest what has happened in NATO over many years since his days in the Foreign Office and that he follows carefully what happens in Europe. His comment on expenditure on defence by European allies is valid in terms of a comparison, but it would be unwise for any Defence Minister to suggest to other countries exactly what they should be spending on defence. However, the comparison is valid and my noble friend makes his point well, as he does with his point about the caveats that are sometimes made by those who are willing to deploy. I remind my noble friend of what I said earlier: more countries are giving more aid now than happened a few years ago, and we have also been able to get more countries to assist with some of the equipment that is needed. While there have been problems, and we would still like our allies to do more, there has been some improvement, which is important.
	In respect of poppies and opium production, my noble friend is right to say that this is a significant part of the Afghan GNP—I think about 30 per cent—and it is linked to criminality and the control that the Taliban has in certain areas. It is destabilising for many; it prevents them getting an alternative existence because of the way in which those factors work together. Yet, when I was in Afghanistan a couple of months ago, real efforts were being made to get people to grow other crops. Wheat was mentioned at that time because the conditions are favourable, and given the world price of wheat, there has to be some potential there.
	My noble friend mentioned a global shortage of medical opiates. I have heard that argument before and looked into it. The International Narcotic Control Board says that there is not a problem with the availability of licit opiates, but there have been some production problems with diamorphine. They have been limited, but it is not due to a lack of raw material. According to the Department of Health the situation improved in 2007, which is expected to continue in 2008. Our real efforts should be directed towards bearing down on proper production per se.

Lord Mayhew of Twysden: My Lords, is it not crucial to the consolidation of our military successes, which we all so greatly admire, that our parallel civilian effort should be planned and delivered by a clear chain of command with a single, identified decision taker at its head? Do the Government accept that? For how long, if at all, has it been in place?

Baroness Taylor of Bolton: My Lords, the noble and learned Lord is quite right to say that we need to plan for the future, and should do so in conjunction with the Afghans. We need to have co-ordination. He will know that Kai Eide has been appointed as the civilian co-ordinator on these matters and that people in the Foreign Office, the MoD and indeed, DfID work closely together. All have representatives in Afghanistan to ensure that there is as much co-ordination as possible.

Lord Ramsbotham: My Lords, I recently had the great privilege to visit our forces in Afghanistan. As a former soldier, the one word that I come back with is "pride"—immense pride in all that they are doing and how they are doing it. However, as a former adjutant general and the one responsible for personnel, I came back with some concerns that were not reflected in the Statement.
	I refer to the sustainment and long-term ability of the Armed Forces to maintain the numbers, standard of training and professional performance over time. The Armed Forces can ill afford to lose people of the calibre of Brigadier Butler who happened to be in my regiment and who was mentioned, and others. It is not just them. I was worried by the haemorrhaging of pilots and skilled crews in the Apache regiment, which is a crucial part of our operation, people in the logistics organisation, the middle piece of regiments—the sort of sergeants' mess of potential young officers leaving after six years. I did not get the feeling from talking to them that the arrangements needed to maintain sustainment of their regiments into the future were sufficiently well supported. Will the Minister say how happy she is with that position?

Baroness Taylor of Bolton: My Lords, the noble Lord brings far more experience to this topic than I do and I am glad that he reported back from his visit to Afghanistan saying that pride was the first word that came to his mind. We all have concerns about how we make sure that we do the very best by those who go on operations and risk their lives. We have lost people from the Armed Forces—that has probably always been the case—but the word "haemorrhaging" is not the impression that I have got from talking to people who are directly responsible for our Armed Forces today. We have to make sure that our standards are maintained, that our training is good and that our equipment is the best that we can provide. There is a great deal of confidence that the overall effort is extremely purposeful. Many people feel that they are fulfilling the role they have always wanted to fulfil in making a difference in a vital situation. That satisfaction is what leads to much of the pride and many of those serving in Afghanistan get a lot of job satisfaction, despite all those pressures. We should look after them but the fact that most of them come back feeling that they have done a job that was worth doing is something that we should be reassured by.

Lord Brooke of Sutton Mandeville: My Lords, I congratulate the Government on a Statement which bore a close resemblance to the transcript distributed to us in advance, which itself is an index of greater stability and confidence. To revert to what the Statement calls "the civil effect", what planned complement of personnel do the British NGOs working in the country have and what proportion is being delivered on the ground?

Baroness Taylor of Bolton: My Lords, the noble Lord hits on a very significant point. We have had to work out how those NGOs that are willing to go to Afghanistan and be deployed there are able to work throughout the country rather than only in certain areas. This is one of the difficulties that we have had because some areas have been extremely dangerous and the overall picture has been somewhat patchy. As I said earlier, 90 per cent of the violence is now in just 10 per cent of the country, so we can make a difference throughout a wider area. In terms of engineering and the development of water and hospitals, we have had a good deal of co-operation from a large number of NGOs that are making a difference to the lives of ordinary people in Afghanistan.

Lord Stoddart of Swindon: My Lords—

Lord Hylton: My Lords—

Lord Davies of Oldham: There is time for both, my Lords, but it is this side's turn.

Lord Stoddart of Swindon: My Lords, it seems a long time now since the then Foreign Secretary, when sending our troops into Afghanistan, said that he hoped they would not be there for long and could leave without firing a shot. Do the Government have any estimates of how long British troops are likely to remain in Afghanistan, of the number of killed and injured which will be tolerated, and of the total cost of the operation over the estimated time? Finally, I do not think that the Minister answered the question put to her by the noble Lord, Lord Lee, about the threat of President Karzai to commit troops across the border in Afghanistan.

Baroness Taylor of Bolton: My Lords, on the last point I said that the problems of the border could not be solved simply by patrolling that border. Discussions and negotiations were needed between the two countries, which face similar problems on either side of that border.
	We are not giving a target for how long we will remain in Afghanistan. We have said that this is going to take a long time. Nor have we given a target for the total cost. We should not underestimate the nature of the task. Afghanistan has been very unstable for a long time. It is, as I said earlier, the fourth poorest country in the world, so it will take a great effort on the part of a large number of Governments—not just Britain by any means—to turn that country round. The noble Lord suggests that we should think of the total cost. However, we also have to consider what the cost would be of not being in Afghanistan, in terms not just of the drug issues, since it would allow even more opium to be produced, but of harbouring terrorists, because we have seen in the past what happens if organisations such as al-Qaeda have a free haven. The costs of not being involved in Afghanistan would be very great indeed.

Lord Hylton: My Lords, the Statement says:
	"We will continue to train the Afghan National Police".
	Can the Minister clear up whether this means throughout the whole of Afghanistan or only within the British military areas of responsibility? I understood that Germany was taking the lead on police training. Does that continue? Could the noble Baroness say whether Britain is securing a fair share of the $2 billion per year police training budget? Has police training at least started in Helmand and Kandahar provinces?

Baroness Taylor of Bolton: My Lords, we are involved in police training, just as we are involved in training the Afghan National Army. Different countries are willing to take a lead on different issues, and as the noble Lord points out, Germany has said that this is one of the areas that it feels comfortable taking on. I cannot give him the apportionment of the costs off the top of my head but I will write to him. Police training is taking place in the south as well as in other areas.

Lord Tebbit: My Lords, in answer to a question about the sustainability of the operations, and particularly the retention of our troops, the noble Baroness said: "We"—I take it she meant Her Majesty's Government—
	"will do all we can to ensure that".
	Would that include paying our soldiers a proper rate of pay?

Baroness Taylor of Bolton: My Lords, the noble Lord, Lord Tebbit, will know that last year's pay increase for the Armed Forces was considerably above that for the rest of the public sector. We should be proud of that, and we have this year accepted the recommendation of the Armed Forces Pay Review Body. We have done many other things to help those on operations and I am not ashamed of and do not apologise for the priority that we have given to supporting our Armed Forces.

Lord Marlesford: My Lords, given that this is a NATO operation, mandated and underwritten in international law by a Security Council resolution, it is absolutely right that, as we have the finest forces in the world, we should contribute to it, provided that the Government are satisfied that we have sufficient personnel and equipment to fulfil the role properly. But is there any reason why we should be paying the cost of our military contribution? Would it not be much fairer if all the members of NATO, including the countries which make a military contribution, paid into a fund in proportion to their GDP to finance the entire NATO military operation, and that those countries which make a contribution should be fully refunded from that fund?

Baroness Taylor of Bolton: My Lords, that is an interesting suggestion and one that I have not heard. I reiterate that 40 nations now contribute to the operations in Afghanistan. That is a significant improvement on the early days and we look to build on that. More people are going some way to pull their weight.

Baroness Carnegy of Lour: My Lords, I am told that there is a serious shortage of doctors in Afghanistan to care for the injured and, indeed, for the general health of our forces there. Is that the case?

Baroness Taylor of Bolton: My Lords, when I was in Afghanistan a couple of months ago, I visited our field hospital. I was surprised by the facilities there, how modern, up to date and advanced they were, and I heard no complaints whatever from any of our Armed Forces that there was any shortage. Our Armed Forces are well looked after on operations and some of our developments have made them the leading armed forces in the world when it comes to making sure that proper attention is given to those deployed.

Political Parties: Funding

Lord Hunt of Kings Heath: My Lords, with the leave of the House, I will now repeat a Statement made in another place by my right honourable friend the Lord Chancellor and Secretary of State for Justice on the funding of political parties. The Statement is as follows:
	"Mr Speaker, the Government are today publishing a White Paper on party finance and expenditure in the United Kingdom. Copies are available in the Vote Office and on my department's website.
	"How our politics is funded is vital for the health of any democratic system, ours included. Over the last decade important steps have been taken towards achieving this. In 1998, the Committee on Standards in Public Life, under its then chairman, the noble Lord, Lord Neill of Bladen, published a landmark report, which went on to form the basis of the Political Parties, Elections and Referendums Act 2000.
	"It must also be fundamental to the health of our democracy that the regime for regulating political parties should never be used as a partisan tool by one party against others and, instead, that change should be by way of broad cross-party agreement and achieved in a manner which carries wider public support. It was that spirit which led to the passage of the 2000 Act by consensus, and which continues to be a guiding principle for this and, I hope, any Government's approach.
	"The 2000 Act represented the first major overhaul of the regulation of party funding and expenditure for over 100 years. It has greatly helped to improve transparency and standards. But it has not proved sufficient. In the intervening period there has been continuing public disquiet about many aspects of how parties and politicians are funded.
	"In March 2006, Sir Hayden Phillips was therefore invited by the then Prime Minister Tony Blair to conduct a further review, including as to whether state funding should be enhanced in return for a cap on donations. Sir Hayden's final report was published in this House on 15 March 2007. It made major recommendations for reform of the Electoral Commission, for tightening of controls on expenditure, for greater transparency and for a gradual move to enhanced state funding linked to a cap on donations.
	"All parties explicitly welcomed Sir Hayden's report and accepted its main recommendations, including those for cross-party talks chaired by him to take forward the report's recommendations.
	"These talks proceeded satisfactorily until the Summer Recess. Sir Hayden then issued detailed proposals based on what he judged might form the basis for a consensus between the parties. It is a matter of great regret that in late October one of the parties decided to walk out of the talks, making agreement impossible.
	"Against this background Her Majesty's Government undertook in the Queen's Speech to bring forward proposals on party finance and expenditure. This White Paper is the result. It proposes measures to improve the regulatory system. It sets out the Government's aspiration for long-term comprehensive reform, building on the model proposed by Sir Hayden Phillips. In those areas where the Government believe broad consensus exists, it outlines plans to bring forward immediate legislation, including reform of the Electoral Commission and more effective controls on candidate spending.
	"It is the excessive spending by parties and candidates which gives rise to the wider problems with party finance which we see today. Repeated independent reviews—including those from Sir Hayden Phillips, the Committee on Standards in Public Life and the Constitutional Affairs Committee—have called the problem one of a 'spending arms race', although some individuals still question its existence. A spending arms race is evident within each electoral cycle. As Sir Hayden's report said, spending by the two largest parties was £90 million between them in the 12 months preceding the 2005 election, up from £65 million in the 12 months before the 2001 election. That was despite the fact that the campaign limit was set at £20 million for each party. Although parties did not act unlawfully, their ability to spend well above the campaign spending limit in the Act reveals a problem with the rules. In the interests of democracy, we need finally to achieve what all parties had sought to do through the 2000 Act, and stop this damaging arms race.
	"The White Paper proposes some important steps for immediate action. Strengthening the Electoral Commission will send a clear signal that politics and politicians are effectively scrutinised—never above the law. The Electoral Commission will have robust civil sanctions to deploy, with criminal proceedings as an alternative. The commission will have more effective investigatory powers, enabling it to access information from anybody where it suspects a breach of the rules. Its governance arrangements will be overhauled better to ensure that there is greater practical experience available to it. The Committee on Standards in Public Life, the Constitutional Affairs Select Committee and Sir Hayden Phillips all recommended that the commission would benefit from the knowledge and judgment of individuals with political backgrounds. So we propose, as the Committee on Standards in Public Life recommended, the appointment of four commissioners with recent political experience and fewer restrictions on staff appointments. Far from politicising the commission, this will, in fact, enable the commission better to understand the people it is regulating and so help it to do a more effective job.
	"There has been widespread concern that a loophole in the 2000 Act has allowed certain unincorporated associations to obscure the original source of donations to parties. As the Phillips review proposed, these will be better regulated, as will third-party campaigning organisations.
	"Let me turn to spending by parties. In 2000, when I took through the Political Parties, Elections and Referendums Act, all believed that we were, in the words of the report of the noble Lord, Lord Neill, "buttressing" the existing restrictions on spending including those contained in the Representation of the People Act 1983 and its predecessors. What we did not foresee at that time was the likelihood of significant increased and unregulated candidate spending as a result of the detailed drafting of the Bill; though from the Conservative Front Bench, the late Lord Mackay of Ardbrecknish, sought to alert us to this problem by moving a clarifying amendment on behalf of his party. The White Paper therefore proposes a return to the system of "triggering", which will regulate all candidates' spending directed towards electoral success and which was a key feature of the previous Administration's 1983 Act.
	"A stronger, more focused Electoral Commission will help to ensure that the previous uncertainty about these rules will be avoided. In parallel with this, we propose to re-examine the list of activities which are defined as campaign spending.
	"Let me turn to the question of introducing donation caps in return for enhanced state funding. To do this, we would have to have not only all the main parties with us, but the public—the taxpayer—as well. This is not the case at present. We are very ready to have that debate and, indeed, to discuss donation caps at a lower level than Sir Hayden recommended, but that will require us to come together to have the debate between the parties and the public.
	"My intention is to introduce a Bill before this Summer Recess, but with its Second Reading in the early autumn and the other stages of the Bill carried over into the next Session. This will allow ample opportunity for scrutiny.
	"By any international comparison the standards of our political system have long been high, and nothing infuriates most Members of Parliament, local councillors and especially the thousands of unpaid voluntary activists in all parties more than the fact that their work and good faith can be tainted by the failures of a very few. But perceptions matter hugely. So I hope the whole House recognises the imperative in this situation of strengthening the probity of British politics and of people's faith in our democratic process as a whole. That is the principal aim of this White Paper and we hope that all parties will support us in this endeavour. I commend this Statement and the White Paper to the House".
	My Lords, that concludes the Statement.

Lord Henley: My Lords, I am, as always, grateful to the noble Lord for repeating the Statement. It has been a pretty extraordinary day, with some three Statements brought before the House by the Government. First, we had the further tragic news coming from Afghanistan and we are shortly to hear from the Foreign Secretary or his delegate in this House, no doubt bringing a piece of white paper to wave before the House, having discussed the Irish referendum with his colleagues in Europe. In between those two Statements, the Government have squeezed in this small Statement on party funding. The noble Lord might think back to that special adviser of one of his former colleagues who talked about a good day for burying bad news. I repeat that.
	That is what this Statement is about. We all know where the Labour Party's support is in the polls. We all remember what happened in the recent local elections. We all remember the Crewe and Nantwich by-election. What happened before then to its fundraising? I do not recall any enthusiasm by the Labour Party, when it was doing so well, for bringing forward such proposals as this. We should not complain. This is a case of "the sinner repenteth".
	We all agree that the reform of party funding is part of a programme needed to restore trust in our politics—although I think that keeping promises on things such as the EU referendum are equally important. The noble Lord might consider that as well. There is a perception that large donations—whether by individuals, shadowy purpose-built partnerships incorporated on Fifth Avenue or organisations such as trade unions—can buy undue influence over policy or patronage. That is why we tabled radical proposals in early 2006, why we supported the subsequent appointment of Sir Hayden Phillips and took part constructively in those discussions. As evidence of our commitment, we accepted that as part of an overall settlement, there could be an increase in state funding for parties, even though we neither seek it nor think it desirable. Many people think it would be a sad day if parties became predominantly dependent on the state. Nor do we accept that there is an arms race in spending between the parties. I would like to see what evidence there is beside the assertions in the report from the Neill committee. However, we accepted that there could be overall caps on spending by parties even though all the evidence is that it is how money is raised that the public worry about, not how it is spent.
	It was explicitly accepted by the then Prime Minister, Mr Tony Blair, that there would be no no-go areas in the discussions. In particular, union funding would not be exempt from any donation caps. Does the noble Lord accept that three things were always understood between the parties: first, that reform had to be comprehensive; secondly, that there should be no cherry-picking of proposals for legislation by the Government to serve their own party's partisan interests; and thirdly, that nothing would be agreed until everything was agreed?
	There is much in the Statement that is neutral in its effects as between the parties, especially in terms of reform of the Electoral Commission, whose record has been disappointing and which has presided over a calamitous so-called modernisation of our voting systems, which has, as your Lordships' House repeatedly warned, enabled increased fraud and undermined trust in our electoral system. However, there is no cross-party consensus on the key areas of caps on donations and spending, and on additional state funding. The discussions came close to agreement, but will the Minister not accept that they foundered on the key issue of whether trade union donations should be subject to donation caps on the same basis as other donations? Why should they not be? Why did the Minister's right honourable friend, Mr Straw, refuse to discuss giving union members the right to a real choice over whether to pay the political levy? Could it be anything to do with the state of finances of the Labour Party? Does the noble Lord acknowledge that when less than half of union members vote Labour, let alone want to support it financially—and yet unions declare that 100 per cent of their members are paying the political levy to Labour—the idea that these are voluntary donations carries little conviction?
	Will the noble Lord also accept that it would be unthinkable for Government to force through caps on what parliamentary candidates can spend from money that they have raised privately, while sitting MPs can spend ever more of taxpayers' money, as they do, on promoting themselves? We came close to an overall comprehensive agreement that could genuinely have started to repair the public's trust in politics. As my right honourable friend Francis Maude said again today, we could still do so. But it would require the Government to accept that dependence on a small number of union bosses has to end. One party's dependence on union bosses must not prevent us getting the reform our politics so desperately needs. We are still ready to work for agreement on fair rules that affect everyone, but we cannot accept a one-sided partisan Bill that the Government intend to bring forward designed to protect the interests of the governing party at the expense of all other parties in the country.

Lord Rennard: My Lords, the proposals outlined are a very modest step towards the further necessary reform of the system for controlling the funding and expenditure of political parties. Of course, they will be welcomed on these Benches, although I suspect that we and many others will wish that they had gone much further than is proposed. The appointment of some members of the Electoral Commission with hands-on party political experience will be very welcome and was argued for by these Benches and by others with relevant experience during the passage of the legislation in 2000.
	We want the Commission to be effective and realistic. We believe that these proposals will help. We want it to have greater investigatory powers and for it to flush out into the open the activities of unincorporated associations that try to hide behind a cloak of anonymity to fund certain political parties. The proposals for expenditure controls are very modest. We argued in 2000 for lower limits to what parties can spend during election campaigns. Reintroducing the trigger for the start of the period in which election expenses are limited and increasing the categories for expenditure that must be included within limits will help. But it would have been easier and better to have simply reduced the amounts that parties can legally spend. Reducing the disproportionate influence of a few rich men—a number of whom sit in this House or have aspired to do so—is a worthy aim. But these proposals do not substantially address the problem that our system allows millions of pounds to be worth more in real influence than millions of votes.
	I hope that the Minister will confirm that this is not the Government's last word on party funding. He will understand that we seek to go further more rapidly. Furthermore, will he accept that while no one party should be able to secure partisan advantage by changing the system in its favour, no one party should be able to benefit disproportionately from the largesse of a few millionaires by vetoing further steps towards reform?

Lord Hunt of Kings Heath: My Lords, I thank both noble Lords for their comments on the Statement. The noble Lord, Lord Henley referred to this as the squeezed Statement in the middle. I rather thought that we were the generous filling in the middle. We will see where that gets us.
	I agree that the whole question of party funding is important, as is public confidence. It is a matter of genuine regret that the noble Lord's party has moved so far from where it appeared to be when the Hayden Phillips proposals were first announced. I remind the noble Lord that his noble friend Lord Strathclyde said on 15 March 2007:
	"We ... welcome the report. We accept its main recommendations". [Official Report, Lords, 15/3/07; col. 907.]
	What a great pity it is that his party chose to walk away at a moment when agreement seemed possible. I do not usually quote from members of the Liberal Democrat Party, but as Mr David Heath said on 30 October 2007:
	"For the Conservatives to now ... walk away is a tragedy and is very short-sighted on their part".
	Hear, hear, my Lords.
	As I said in the Statement, the proposal about state funding, which came from the work of Hayden Phillips, helps to acknowledge that if there were a cap on donations, there would be a shortfall in funding. As the Statement makes clear, we believe that there would have to be political consensus on that matter and clear, public support. We do not think that we are in that position at the moment but we stand ready to discuss this further with the political parties.
	On trade union funding, it is worth recalling that Hayden Phillips said in his work that affiliation fees may be regarded as individual donations, provided that there was transparency and the funds were traceable back to individual donations. I say to the noble Lord that donations to trade unions are already more regulated than donations from other organisations. The new committee's report of 1998 said that no case for reform in relation to trade unions had been made. I remind the noble Lord that the evidence from his party in 1998 was that it was not illegitimate for the trade union movement to provide support for political parties. I also point out that in 2005, only 45 per cent of political funds from affiliated trade unions went to the Labour Party; that the 10-year ballots that trade unions have to have show continuous support for them to have political funds; and that between 2000 and 2006, only three complaints were received about this matter by the certification officer regarding political funds, two of which were withdrawn and one of which was not upheld. Around 10 per cent of trade union members opt out of making political funds. The trade union and Labour Party organisations have confirmed that they have agreed to respond positively to the Hayden Phillips proposals about transparency and traceability by including clear information about political funds on membership forms and moving over time to full affiliation of all levy-paying members.
	The noble Lord, Lord Henley, referred to incumbent funds or the communications allowance. That is available to all MPs to enable them to do their constituency role. The communications allowance was unanimously approved by an all-party committee of senior MPs—the Members Estimate Committee—which included Members from his own party. He said that he does not believe that there is an arms race but the reports state that the estimated expenditure of his party and my party in 2005 was £90 million; that is up from £65 million in 2001. I would have thought that that was very clear evidence indeed of an arms race. Given that the talks had gone so well, it was a very great pity indeed that the noble Lord's party chose to walk away at the last moment.
	The noble Lord, Lord Rennard, said that the proposals were modest; none the less, they are important. As he said, changes to the Electoral Commission—greater focus on ensuring integrity of the system, greater sanctions, greater investigatory powers and the appointment of commissioners who have some experience of the political process—should enhance its role as an effective regulatory body. On the more fundamental issues, this is not, of course, the last word. I agree with the noble Lord that no one party should have a veto. However, it is in the public interest that we should try to achieve as much consensus as possible.

Lord Campbell-Savours: My Lords, why do we need consensus on the question of a cap? What is so desperately important about that consensus?

Lord Hunt of Kings Heath: My Lords, in terms of the integrity of the political process and how the public regard the political parties and their finances, the arrangement is likely to command much more confidence if there is general agreement, as we had with the Hayden Phillips review and the cross-party discussions. It is sad that we are not there but that does not mean that we should not strive for that again.

Lord Hamilton of Epsom: My Lords, is the Minister entirely comfortable with incumbent funds and the communications allowance, which normally amounts to a glossy that comes out shortly before local elections telling us about all the wonderful things that the Member of Parliament has done? Under any of the old rules, the sitting Member always had an advantage over the candidates who stood against him because he communicated with his constituents. Is it really right that taxpayers' money should be used to enhance the position of a sitting Member to the disadvantage of the candidates who oppose him in an election?

Lord Hunt of Kings Heath: My Lords, I do not think that there is much that I can add to the comments that I have already made. The noble Lord referred to the communications allowance, which is set at £10,000 per Member with a cap of £7,000 on the provision of pre-paid envelopes. As I said, this was unanimously agreed by the relevant House of Commons committee. It clearly is applicable to all MPs from whichever party they come. In an era in which all of us are concerned about the engagement between politicians and the public, I should have thought that anything that helped Members of Parliament to communicate effectively with the people living in their constituency would be welcomed.

Lord Goodhart: My Lords, does the Minister agree that parties should have funding in elections that is broadly on a level playing field and that allowing very wealthy individuals to donate vast sums—in six or even seven figures—distorts the whole political process? Does he also agree that parties should be encouraged to obtain small donations from many people? I should add that I was a member of the Committee on Standards in Public Life—we researched and published our principal report in 1998. One method that we suggested then, which might have a number of virtues, would be something in the nature of a gift aid scheme for donations to political parties. Making modest donations to parties benefits the democratic system and it should be recognised that it does so. On the involvement of the tax system, that is already recognised in relation to inheritance tax, where donations to established political parties are tax exempt. Since inheritance tax is mainly paid by those who are supporters of the Conservative Party, would it not be fairer to extend similar tax relief to small payments such as membership subscription?

Lord Hunt of Kings Heath: My Lords, I am sure that my right honourable friends in the Treasury are always interested to hear of suggestions about taxation and tax incentives. On the substantive point, I am sure that all of us who are concerned about the health of our democracy would wish to see as many people as possible make contributions to the political party of their choice. Anything that we can do to encourage that should be considered very seriously, particularly at a time when all of us are concerned about overall reductions in the numbers of people actively involved in party political activities. In the—

Lord Neill of Bladen: My Lords—

Lord Hunt of Kings Heath: My Lords, I am responding to the noble Lord, Lord Goodhart. He will know that Hayden Phillips, in the work being discussed, suggested incentive payments of £10 provided by the state for every £10 raised by the political parties. We do not think that we are in a position to go forward with state funding for the reasons that I have given. However, we very much welcome anything that we can do to encourage as many people as possible to participate and donate.

Lord Grocott: My Lords, is it not the case that, while my noble friend's Statement quite rightly focuses both on income and expenditure, for those of us—I hope that it is all of us—who feel that money should not determine the outcome of elections, expenditure is more important than income? That has been the thrust of most electoral law since control on candidates' expenditure was first introduced at the end of the 19th century.
	We have had many views on what is going on across the Atlantic where much is said about how wonderful the system is and how it reinvigorates politics. However, what is disturbing to all of us are the colossal sums of money that have to be raised in order for a democratic election to take place these days. Can my noble friend, particularly in the light of those views, that the focus of his attention will be on limiting the amount of money that individual candidates can spend on their campaigns in their constituencies and on putting a tough cap—which I would make more severe than it is at present—on the total amount of money that can be spent in the national campaign? Whatever language we use, it is the expenditure of parties which clearly makes it grossly unfair if one is spending far more than the other.

Lord Hunt of Kings Heath: My Lords, I certainly agree with my noble friend on his general premise that money should not determine the outcome of the elections. I am sure that he is right to point to some of the lessons that can be learnt from the US. There are lessons to be learned both ways here: we can also learn from the US in the way that many individuals—this goes back to what the noble Lord, Lord Goodhart, said—make contributions to political parties as well. In a sense, it is an endeavour to embrace good examples of a wider involvement in the political process and not the kind of arms race that I have described, and to which he has referred.
	The extra spending in the 2005 election as compared to 2001 is a warning of what might happen. That is why we must keep these matters under very close review and why we very much welcome the continuance of a cross-party debate on those matters.

Lord Fowler: My Lords, some things in this Statement are obviously welcomed. However, the Minister said, and has made it continually clear, that there are going to be no limits on donations, including trade union contributions. Does that not mean that this measure will not tackle one of the fundamental defects in the present party funding system; namely, the way that trade unions can assert their right to have policies accepted in return for the contributions they make? "No say, no pay" is how one trade union leader once put it. Does the Minister not understand that, until that is tackled, this Statement and White Paper will be seen as not only incomplete, but as a party political measure?

Lord Hunt of Kings Heath: My Lords, I cannot possibly see why this would be seen as a party political measure. All the proposals in today's Statement have been the subject of considerable discussion and many of the reports that have come forward in the past few years have covered that ground. I do not recognise what the noble Lord, Lord Fowler, says with regard to the relationship between trade unions and the Labour Party. What I do recognise is that this is a highly regulated area and that his own party, in evidence to the committee of the noble Lord, Lord Neill of Bladen, only a few years ago, made no recommendations of any substance in that area. In relation to the opportunity that people have to make complaints about how the system works, very few complaints have been made.

Lord Foulkes of Cumnock: My Lords, I assure my noble friend that I had intended to ask a non-partisan, non-contentious question about the Electoral Commission until the anti-trade union tirade from the noble Lords, Lord Henley and Lord Fowler, which was not unexpected in either case. Instead, I ask my noble friend whether he shares my disappointment that the two greatest experts in this House on party funding are unable to be present today. One of them, who promised the appointments committee that he would relocate his domicile in the United Kingdom, failed to do so and so is effectively barred from attendance in this House. The other one, who bankrolls the Tory party at national and local levels, is effectively resident in Belize. Does that not say a great deal about the modern-day Tory party?

Lord Hunt of Kings Heath: My Lords, I always find that my noble friend brings to your Lordships' House an entirely impartial and balanced view on these matters.

Lord Shutt of Greetland: My Lords, much as I would like to speak on the real substance of this debate, there is a very important Chief Whip's point that I should like to raise. Over the past three or four years I have been concerned about the provision of funds for the political parties within Parliament, in particular the position of the Cranborne money, with regard to which the figures available have been created by some system of great mystery. I have been told that this would be something which would be attended to within the slipstream of whatever came from the Hayden Phillips's activities. Therefore, I should like to ask whether it is intended that these things can be attended to in the slipstream.
	Only a few weeks ago, because of the Cross-Benchers' inadequate resources here, an emergency dispensation was made. It is important that this should be looked at. I hope that the Minister can answer in the affirmative that this can be coped with in whatever Bill is proposed in the near future.

Lord Hunt of Kings Heath: My Lords, I am not at all sure that the issue of Cranborne money is in my gift, although I note what the noble Lord says. I also note that his party received £228,445 in 2007-08, while the Conservative Party received £457,000 and the Cross-Benchers £41,000. My noble friend the Lord President is aware of these matters and would be happy, I am sure, to engage with other Members of the House on them.

Lord Brooke of Sutton Mandeville: My Lords, I declare an interest as the Minister in the then-Government who reached complete agreement with the noble Baroness, Lady Gould, on the subject of the level of expenses in parliamentary by-elections in 1989, to the great relief of agents of all three major parties throughout the country.
	Will the strengthening of the Electoral Commission—both as to quality and powers—be reflected in a greater willingness of the Government to accept its advice, especially in the area of postal votes, where in recent years the posture of the Government would have secured the admiration of Dr Pangloss?

Lord Hunt of Kings Heath: My Lords, that is not an entirely fair representation of the Government's actions in this matter. We listen with very great care to recommendations made by the Electoral Commission. In fact, the noble Lord will know that we have made changes. We are looking at these matters very seriously and continue to discuss them in relation to the question of individual voter registration, which I suspect he had in mind. We hope that the actions we have announced today will strengthen the future effectiveness of the Electoral Commission. I am sure that a strengthened commission will be listened to by government even more eagerly than is the case now.

Lord Stoddart of Swindon: My Lords, it is true that the Statement and the White Paper are about party financing but what we really need to be concerned about is the public's participation in the political process. The White Paper does not deal with that at all; it simply deals with the financing of political parties. At present, political parties are held in great disdain by the public and we need to return to the days of active participation in political parties by the people of this country. When I joined the Labour Party—I was expelled a few years ago but I remember when I joined it in 1947—it had 1 million individual members and 14 million trade union members. The Tory party had 3 million individual members, and I think that even the Liberal Party had about 40,000 members. Therefore, at that time people were involved in the political process. Now, they feel divorced from it and nothing in the White Paper will alter that. Only decent policies and activity on the ground will bring back the public.

Lord Hunt of Kings Heath: My Lords, first, I agree with the noble Lord that this is a very important matter, but it really is outside the scope of the Statement and the White Paper. However, I say to the noble Lord that the more public confidence we can bring about by ensuring that party funding is dealt with as transparently and effectively as possible, the more likely it is that members of the public will be willing to engage in the political process. I absolutely agree that political parties have a critical role to play in the future health of our democracy, and the more we can engage with and encourage members of the public to take part in political activities, the better our democracy will be.

Viscount Astor: My Lords, will the Minister remind his noble friend Lord Foulkes—in a non-partisan way, of course—that the largest donor to any political party in this House was a Minister who used to sit on the Government's Front Bench and whose name is somewhat similar to a well known high-street chain of supermarkets?

Lord Hunt of Kings Heath: My Lords, I have been a little too long in this job to offer any advice to my noble friend.

EU: Lisbon Treaty

Baroness Ashton of Upholland: My Lords, with the leave of the House, I shall now repeat a Statement made by my right honourable friend the Foreign Secretary in another place.
	"With permission, Mr Speaker, I should like to make a Statement about the Irish referendum on the Lisbon treaty held last Thursday. The 'no' vote on the treaty in the referendum is important because of our strong national interest in an effective European Union, and it needs to be respected.
	"The next step is for the Irish Government to give their views on how to proceed from here, consistent with their aims for Ireland's role in the European Union. They have made clear that they need time to absorb and analyse the result and its implications, and to consult widely at home and abroad. The Irish Prime Minister has said he is disappointed by the result but wants Ireland to continue to play a full part in the life of the European Union.
	"I have just returned from a meeting of EU Foreign Ministers in Luxembourg and that message was reiterated by the Irish Foreign Minister. He emphasised the diverse nature of the Irish debate and the overlap in the debate between issues affected by the treaty and those not. He also expressed his appreciation that around Europe leaders had committed themselves to work co-operatively with Ireland. He committed Ireland to work for a common European approach with Ireland at the heart of Europe. There will be further discussion among Heads of State and Government and Foreign Ministers at the European Council this Thursday and Friday—not to take final decisions but to hear a preliminary report from the Irish Government and preliminary thoughts on the next steps.
	"The rules of the treaty and the European Union are clear. All 27 member states must ratify the treaty for it to come into force. There is no question of ignoring the Irish vote or bulldozing Irish opinion. Ireland clearly cannot be bound by changes which it has not ratified. Equally, there is no appetite for a return to years of institutional negotiation. The EU as a whole needs to find a way forward for all countries that allows it to focus on the big policy issues that confront us.
	"Eighteen countries have approved the Lisbon treaty. The Irish Government have set out clearly their respect for the right of other countries to complete their ratification processes. My conversations with other Foreign Ministers, representing all shades of political opinion across the European Union, show this to be a very strong view. The reason for this approach is simple: an Irish vote is determinant of an Irish position but cannot determine the ratification decision of other countries. The British view is for this Parliament to determine.
	"In this House and the other place there have been 24 days of debate, and both Houses have voted strongly in favour of the European Union (Amendment) Bill at each stage. The final stage is the Third Reading in the other place on Wednesday. The Government believe that ratification should proceed as planned. It must be right that every country takes its own view on the treaty in accordance with its democratic traditions. That is right according to democratic principle; it is right in terms of our negotiating position in the European Union; and it is right in terms of our national interest.
	"Our national interest is a strong Britain in a strong European Union. The EU now consists of 27 countries and more than 490 million people. Reform of EU institutions and working practices is important to ensure that the EU can function more effectively and cohesively, and also to ensure that it embraces an outward-looking agenda that tackles in an effective way international issues such as migration, climate change, security and defence policy, and counterterrorism. But treaty change rightly requires unanimity across all countries. That is why it is right that we take the time to allow the Irish Government to make proposals on what to do next; right that we assert Britain's national interest in an effective European Union that addresses the problems of the modern world; and right that we work to maintain the cohesion of the European Union. That is what the Government will be doing in the weeks and months ahead, and I commend this approach to the House".
	My Lords, that concludes the Statement.

Lord Howell of Guildford: My Lords, I thank the noble Baroness the Leader of the House for repeating this Statement by the Foreign Secretary, who has just returned from meeting his fellow Ministers, although I heard much of what he said and what she repeated with incredulity. That approach may commend itself to the other place—I am not sure whether it does—but it certainly should not commend itself to your Lordships' House. The objective facts of this whole situation are absolutely clear. The treaty was negotiated and required the common consent of all EU member countries to come into effect. In the words of the Foreign Secretary, the rules are absolutely clear: unless all 27 member states pass the Lisbon treaty, it cannot pass into law—he repeats something to that effect in the Statement.
	The British Government had many reservations about the treaty—we all know that. They tried and failed to resist many of the features in the final treaty text and attempted to hedge them around with so-called red lines, significant numbers of which were breached, with others having to be protected by various devices and defences, which our discussions on the enacting Bill in recent weeks have shown to be of dubious worth.
	Alone among the European nations, the Irish Government, because they had to, allowed their people a referendum on the treaty. The Irish people have rejected it decisively, and the treaty to be enacted in the Bill before your Lordships' House therefore, if not completely dead, as the Liberal Democrat spokesman was saying earlier this afternoon in the other place, is at least in a deep coma—until and unless the Irish people are told to vote and vote again until they give a different answer, which they are not going to do and which we should not expect them to do.
	Giving the Bill a Third Reading here this Wednesday, which is the implication of what the noble Baroness said—doing it in haste—is absolutely pointless. A new negotiation now obviously has to begin, perhaps after a considerable pause to respond to the Irish concerns. Although there are many interpretations of what those concerns are, we know that a large number of them are shared by a huge number of people in our country and other European states.
	Whether one is for or against the treaty—I know that there are deep divisions in your Lordships' House—the worst tactic in such negotiation would be to pass this wounded and dire Bill in this House on Wednesday next. What would that be saying to the rest of the EU? I do not know why the Foreign Secretary cannot see this. It would be saying, "We, the British Government, are entirely satisfied with the Lisbon treaty as now written. We would not amend one comma of it or change the way we handle it here in the UK. We wish to be included out of any discussions and are entirely content for Mr Barroso to settle with the mischievous people of Ireland on the basis of the present text". In fact, we would be saying that we approve the "isolate Ireland" strategy, which seems to be going the rounds, and will join the bullying camp. I hope that that is not so—I know that the Foreign Secretary has said that it is not so—but that is what we will be doing if we push through Third Reading of a near-dead Bill. To proceed in that way would be folly. It would be giving away our negotiating room, just as the Government gave away our rebate for nothing except castles in the air on the common agricultural policy.
	I confess—I do not have to hide—that I have consistently argued that this is a bad treaty, the wrong treaty, and that we could have done and could do much better for modern Europe, old and new, by moving in more democratic directions, as the Laeken declaration originally required. Wherever you stand, the common-sense approach must be not to proceed further with the Bill at present. If the leaders of the EU attempt to devise some method of proceeding about which Parliament, the British people and, probably, the Government, know nothing, at least the Bill's discussion provides a forum for delivering some parliamentary control of that process, if we keep it alive.
	Although we know that the treaty cannot be amended, the Bill could be brought back later with any new aspects that might come out of any intergovernmental conference or Council, such as new protocols and other adjustments of that kind. The Government could table amendments not to the treaty but to the Bill and they could be fully discussed and debated in both Houses.
	If we complete Third Reading in this House, that becomes impossible. Postponement for a few months is much the wisest course and that is what the Government should now do. At the very least, the Bill must be returned by your Lordships' House to the other place, the elected Chamber, to give the necessary opportunity for the situation to be reassessed. That is our absolute and clear duty. In a way, one could say that it is the Government's good fortune that we are here and can stop the process just in time to give them the chance to act. We can stop the train just before it hits the buffers. That is exactly what we should now do. I cannot believe that any of your Lordships would want otherwise at this stage in our proceedings.
	If the Government will not do the democratic thing and postpone Third Reading, we will certainly table a Motion to do so. If we proceed as if nothing has happened on Wednesday, the Government are in effect asking Parliament to plunge into the unknown, leaving the other place defenceless. That would be a foolish and arrogant course.
	After the Danish referendum, the process of ratification of the Maastricht treaty was suspended. After other repeated referendums in which countries as diverse as Holland, France and Denmark opposed treaty revisions, there was talk of a pause for a reflection. Why is the order of the day this time not "pause for reflection", but "rush on blindly"? That is very dangerous and will do nothing to enhance the strength and cohesion of Europe or of our European policy.
	A dangerous gulf is opening between the elites of Europe and the people of Europe over the direction of the European Union. In an interactive age, when ordinary citizens have been empowered by the internet as never before, the use of imposed, top-down solutions by grandee conventions are no longer practicable or possible. The Governments of Europe have to learn that Europe is for the people and not for its administrators.
	Faced with that gulf, revealed in sharp outline in the Irish referendum last week, we can either recognise the new conditions of life or ignore the new realities. We can cling to the past that is done or we can seek to lay out our new, better vision of Europe in which people truly have a say. We can pause for reflection sensibly or we can plunge on regardless. The right route—the positive route, the route for the future—is to listen and reflect and for the Government then to come back to the elected Chamber and to this reflective House with plans to replace, redesign and remedy the obvious weaknesses of the Lisbon treaty.
	Many small countries throughout the EU would thank us warmly for doing so. Let us not insult Parliament and the public and close off the options for our country by behaving as if nothing occurred last week. Let us pause with the Bill, not least while the Prime Minister goes to the EU Council, which he is about to do. Let us hear what is said there and then let us join in mature debate about any revisions proposed and whether a new treaty and therefore new legislation is required.
	I am personally convinced, and I believe many people in all parties will be convinced, that that is the statesmanlike and sensible course and I beg the noble Baroness—I confess without all that much hope—to find the wisdom to embrace it.

Lord McNally: My Lords, I congratulate the noble Baroness the Lord President on the crispness and brevity of the Statement—clearly the Prime Minister's hand was not in it. I wonder whether she has heard the American expression that it is very difficult to remember that the idea was to drain the swamp when you find yourself up to the armpits in alligators. I hope that she will resist the crocodile tears shed this afternoon and over the weekend by those who have tried at every stage to derail the Bill.
	It is worth wondering what we were trying to do with the Lisbon treaty. It was the treaty that was going to enable the new enlarged Community of 27 to work more efficiently. It was the Conservative Party that had given most support to the idea of enlargement and then worked very hard to deny the way that that enlargement could work. As the Statement recognises, it was the way that Europe could move on from the constitution and navel-gazing to the agenda outlined in the Statement, the relevant agenda for the people of Europe. It is therefore rather odd now to say that we should not continue with the parliamentary process. We welcome the decision in the Statement to go ahead with Third Reading.
	As my honourable friend Ed Davey said earlier today in the other place, not to do so could do further damage if we are seen to jettison the treaty just days before the Governments of Europe meet to discuss its future. Each country was asked to process the matter. The fact that the Irish have processed it in a way that we do not like has nothing to do with the fact that we should process it within our parliamentary system. Indeed, doing this—contrary to what the noble Lord, Lord Howell, was implying—would greatly strengthen the Prime Minister's hand in the discussions that will take place. It would be a sign of Britain's good faith and good intent. Europe cannot be held in suspended animation. I hope that the Prime Minister, when he attends the summit, will impress on his colleagues the need to let the people of Europe know what will happen next. This cannot be done by smoke and mirrors, and it cannot be done by drift. There must be leadership from the summit.
	We must also use this time to think carefully about other issues that have come up during this discussion. I hope that, when considering the constitution Bill, we will look at how we handle treaties in our Parliament. We should not take a short-term view. I also think that we need to look carefully at how—if at all—we use referendums in our parliamentary democracy. The Conservative Party, for short-term political gain, has fallen in love with referendums and is implying that the parliamentary democracy that has served us well for hundreds of years is somehow inferior to referendums—which, as we have seen from the Irish experience, are very prone to distortion and to influence. If the Conservative Party really wants to supplant our parliamentary democracy with a system where, whatever the issue is, it is exposed to the interference and intervention of any eccentric millionaire willing to pour his funds into a campaign, it is treading on very dangerous ground.
	I hope that Third Reading proceeds, because I believe that it is in Britain's national interest. It is also in Britain's national interest, as we have argued constantly from these Benches, that the Government use the opportunity to move to a real debate about Europe that puts the positives of Europe to the British people and allows us to move to centre stage. That has been the aim and argument of this party throughout this process.

Baroness Ashton of Upholland: My Lords, I am grateful to both noble Lords, who set out their positions extremely succinctly and to no great surprise on these Benches. I say to the noble Lord, Lord Howell, that his was a nice try. However, we have had, in your Lordships' House and another place, one of the best series of debates that this Parliament has been fortunate enough to experience. I will not go over all the statistics. We have had 24 days of debate; 10.5 in your Lordships' House, plus the time on this Statement and no doubt time on Wednesday. Three hundred and fifteen amendments were tabled in the Commons and 266 in the Lords. There have been 57 divisions; 12 in your Lordships' House and 45 in another place. I believe that the noble Lord is incorrect to say that we are acting in haste by moving to Third Reading. This has been long scheduled in your Lordships' House and long looked forward to by those of us who have spent many hours in considerable debates. I reject the assertion that this is an in-haste response. I reject the assertion that Parliament has not done its job properly and succinctly in debating the detail of the treaty and the detail of the legislation. I hope that noble Lords will accept the Government's position that we have thought carefully about what should be done and determined that we should finish the process.
	The reason is simple. Each member state undertook to take the issues raised by the treaty to its country and, through the processes available to it, to consider them carefully and to reach a conclusion. We are 96 per cent of the way to reaching that conclusion. Noble Lords will put down what amendments they wish for Third Reading, will determine whether they wish to divide your Lordships' House and will make their decisions accordingly. We on the Government Benches are very clear that we should continue.
	I say to the noble Lord, Lord Howell of Guildford, that it is not a question of the British Government being satisfied; it is a question of Parliament being satisfied. Parliament, having had the benefit of so much debate and deliberation, is saying very strongly what it feels about this treaty and about this legislation. We should make our decisions on Wednesday, send the Bill on its way and see our Prime Minister going to the European Council knowing what the position of the British Parliament is. That would place this country at the heart of Europe and in the best position to discuss and debate with our colleagues across the European Union—and especially with our colleagues in Ireland—what needs to happen next.
	There is no question of bullying or isolating Ireland; that would be completely wrong, completely against what my right honourable friend the Foreign Secretary has already said in another place and in the media, and completely wrong from your Lordships' perspective. That would be inconceivable. What is right is that we are able to participate in those discussions as effectively as possible—not rushing in blindly, as the noble Lord, Lord Howell of Guildford, said, but deliberating properly, knowing what the British Parliament has said, being clear from all the debates and discussions where this nation stands, and being able to discuss effectively with colleagues what should happen next. I hope that we will continue with Third Reading. As has been suggested, that is how our parliamentary democracy will work at its best. I agree with the noble Lord, Lord McNally, that we can then move on to stage the debates about the future of Europe that we have described over these past weeks in the context of the issues that we all face, and that we face far more effectively when we work together.

Lord Elystan-Morgan: My Lords, is it not the case that with regard to the relationship between the United Kingdom and the treaty, and the relationship between this House and the treaty, what happened in Ireland makes no difference whatever? The merits and the demerits of the treaty remain the same as when we discussed this matter last week. We are a sovereign Parliament. The United Kingdom has a responsibility in relation to a treaty that it has agreed to place before Parliament and allow to pass through all its processes.
	Twenty-six countries will not take no for an answer. One country will not take yes for an answer. I respect the Irish people for the decision that they have come to, after facing up to the blandishments and advice of three major parties. They were entitled to do exactly that. That is what freedom and sovereignty really mean. There are, however, immense difficulties. Under Articles 46 and 47 of the Irish constitution, there is no way that they can ratify the treaty save by a referendum. In respect of that referendum, I believe that I am right in saying that, in so far as concerns unanimity, it has to take place before 31 December this year. I ask the Minister: is it possible for the treaty to be extended? If that were to be done, would it of necessity be on a basis of total acceptance by all 27 members; and would even that provision still have to go before the Irish Dáil?

Baroness Ashton of Upholland: My Lords, I am grateful for the points made by the noble Lord about the sovereign nature of the role of Parliament and I hope that I have expressed the view of the Government that that is precisely what we ought to do. On the issue of the date of 31 December, we have agreed that countries will deposit as far as possible their ratifications, but ratification does not have to have taken place by that date; it is more that European nations said that they would try to deposit them. It is the physical provision of a document, and nothing in the treaty states that it has to be done by 31 December.

Lord Radice: My Lords, the result of the referendum in Ireland is a severe setback for the EU, but is it not the case that what happens next is a matter for the Republic of Ireland and the European Council? As far as the UK Parliament is concerned, has not the European Union (Amendment) Bill, which we have been discussing in this House, gone through all stages except for Third Reading? The only sensible course, therefore—and, as the noble Lord, Lord McNally, has said, the only one that will give us a say in what happens next—is for us to proceed with Third Reading.

Baroness Ashton of Upholland: My Lords, I agree completely with my noble friend.

Lord Howe of Aberavon: My Lords, was the noble Baroness as astonished as I was to hear the tone used by the noble Lord, Lord McNally, to denounce my party for our deep affection for referenda, as though we are leading the chase in this? It was his own party, certainly at the outset, that was the most enthusiastic in its pursuit of that solution, one which I regard as unacceptable? But to hear him denouncing my party in that way is to hear him exceeding even his own most astonishing performances. Beyond that, while I hesitate to join my noble friend Lord Howell in introducing the locomotive metaphor that so often confuses these arguments, surely the purpose which has been common to all parties in this House has been to secure enlargement of the European Union and to embrace the democracies which have been brought about by the example of the Union. Is not the greater part of this treaty, which certainly is not perfect in my eyes, destined to secure the steps that are necessary for the European Union to advance with its enlarged membership? Is it not also the case that if there are any doubts about the position of my party, the leader and the spokesman for foreign affairs have both made it very clear that Britain's place should be as part of the European Union? If that is kept in mind while the Council of Ministers and the Irish Government grapple with the extremely difficult problems they are facing, as long as it is clear that the locomotive that started God knows how long ago is intended to be kept on the rails in working condition, is that not the best approach?

Baroness Ashton of Upholland: My Lords, I am not going to get involved in an argument between the Opposition parties, and the noble and learned Lord probably would not expect me to do so. The point made by the noble Lord, Lord Howell, is very important. Both he and the noble Lord, Lord McNally, said that it is important that Europe should move forward and not stand still at this point. Issues need to be discussed, and as I have indicated, the treaty cannot come into effect without the agreement of all 27 nations. Enlargement is something that I trust all noble Lords agree is of great importance and it is vital both that countries work together effectively and that Europe remains a central aspect of our approach in foreign policy. So I agree strongly with what the noble and learned Lord has said.

Lord Tomlinson: My Lords, can my noble friend help me by explaining how we would show respect for the Irish vote by denying ourselves the opportunity to make our own decision? Furthermore, can she assure me that she will not be put off by the hectoring language that so ill suits the noble Lord, Lord Howell, when he talks about "this wounded Bill", giving away our "negotiating room", "bullying", and "plunging" ourselves into the unknown? It is totally unhelpful language that does not sound like any sort of objective advice to Her Majesty's Government.

Baroness Ashton of Upholland: My Lords, I am always mindful of language in your Lordships' House, and we have heard some interesting examples of the use of the vernacular along the way. People speak with enormous passion, and I can live with that. But I agree completely with my noble friend that it does no service to this country, to the people of Ireland or to the people of the European Union not to complete that which we have started, and for the British to determine the British position. We should not have that position determined elsewhere. The British Parliament has debated it at great length; the British Parliament should finish its deliberations, and send our Prime Minister to the Council with that knowledge.

Lord Hamilton of Epsom: My Lords, is the Minister not seriously concerned about the widening gulf between the views of the people of Europe and those of the people in Brussels who purport to represent them? Does she not accept that if there had been referenda in all the 27 nations, there would have been a lot more "no" votes than just that of Ireland?

Baroness Ashton of Upholland: My Lords, I cannot predict what the votes would or would not have been in referenda in any country of the European Union, nor would I seek to do so. Where I agree with the noble Lord is the underlying point I think he makes, which is that it is important to make sure that the people of this country and of every other nation in Europe understand the benefits of being part of the European Union, and of those benefits to them whether they live, work, study or travel across the Union that have been brought about by being a member. It is important to tackle some of the issues we face today across the 27 nations rather than try to be isolationist in our approach. I agree with all of that, but what I would say simply to the noble Lord is that we should complete our processes and then decide how best to take forward these important issues in the European Council.

Lord Hannay of Chiswick: My Lords, will the noble Baroness try to cast some light on the statement of the noble Lord, Lord Howell, that somehow our lives would all be made easier if we suspended consideration of this legislation because if some change took place in Brussels, we would be better placed to take account of it? Surely the situation legally is rather simple: if the Lisbon treaty is in any way renegotiated or changed, it will not be this House but this Parliament which will have to start the process again, and that will not be helped by suspending our deliberations this week. Further, if nothing is done to change the Lisbon treaty, there will not be a case for ourselves being helped by not having passed this legislation.

Baroness Ashton of Upholland: My Lords, the noble Lord is absolutely right to say that we gain nothing by suspension other than sending a rather bizarre message to another place, to the country and to Europe. We should complete the process. If a new treaty were to be negotiated, it would begin its process through another place and your Lordships' House all over again. That would be the way of it.

Baroness Carnegy of Lour: My Lords—

Lord Richard: My Lord—

Lord Bach: My Lords, we have plenty to time to hear from both sides. We have heard from equal numbers except for the Liberal Democrats.

Baroness Carnegy of Lour: My Lords, I love Europe, but I never had the opportunity to be an MEP so I did not have the chance to go native. I simply look at the situation from the point of view of the people of this country and of Europe. Does not the noble Baroness appreciate that the people of Ireland have given us an opportunity to get the European Union to look at certain things again which we would very much like to be improved in this treaty? She is missing an opportunity by not agreeing to suspending consideration of this Bill, which the timing now gives us the chance to do. We have still not finished the Bill and we have had the Irish referendum.
	I hope that the Liberal Democrats will do what they did before and change their minds. They abstained in the Commons on the issue of a referendum, they supported the Government here, and I understand that if they had not done so, this country would have recommended by a minute majority a referendum. I may be wrong, but I understand that to be the case. I hope that they will change their minds between now and next week. Again, does not the Minister accept that we have a marvellous opportunity, one that we are throwing away, to get a little more of what we want out of this treaty? It seems to me that she is letting the people of this country down.

Baroness Ashton of Upholland: My Lords, I am sorry if the noble Baroness thinks I am doing that, but she is simply incorrect. If we were to suspend the treaty, then as the noble Lord, Lord Hannay, has just said, we would have to begin with a new treaty and consider it all over again. I fail to see what evidence there is for what the noble Baroness has said. We have had 57 votes on the treaty in this Parliament. The Government put forward a treaty that they believed was a good deal for this country and a good deal for Europe. We stand by that. We have voted on every issue that Members in another place and noble Lords here have chosen to vote on, and we have made our position very clear. We are at the final stage, so there is nothing to suggest that it would be appropriate at this point to stop. Rather, we should complete the process. If a new treaty were to be brought forward in the future, as the noble Baroness suggests, we would go through the processes properly in both Houses. It is not something we can stop and amend. In my view, that would be completely wrong.

Lord Richard: My Lords, my noble friend has, in making this Statement to the House, expressed the view that we must respect the decision of the Irish people. She is absolutely right: we must respect their decision. The Irish Government, as I understand it, have asked for time to consider what should be done. Can my noble friend help me to this extent? Do the Irish Government have any view as to whether the ratification processes in those other member states that have not yet ratified the treaty should be postponed, held up or completed; or have they—as I suppose they sensibly have—remained silent on this point? The issue, for us, is very simple. Having got this far with this Bill, is it seriously suggested that, because one member state has produced a view on the Bill that does not fit in with the views of other countries that have so far expressed views on it, the whole procedure of this House—and this Parliament—should be negated? It is a fanciful argument. To put it in the quasi-democratic terms of the noble Baroness, it is really a travesty of the position.

Baroness Ashton of Upholland: My Lords, the Irish Government have made it clear that they believe that other member states should continue with their processes. Indeed, as I have indicated, that is what I believe we should do. This is about parliamentary sovereignty and the rights of each member state. We have had many discussions, in the course of our debates, about the desire of noble Lords, on both sides of the House, to ensure that we take our own decisions. This is a decision for us to complete. It is for our Prime Minister to attend the European Council, being clear about what that decision is.

Lord Roper: My Lords, I hope that the noble and learned Lord, Lord Howe, with whom I have been debating these issues in this House and another place for something like 36 years, will accept that there have, at various times, been divisions in all political parties on the issue of referenda, but that my noble friends on these Benches have been fairly adamant in opposing referenda. Does the Minister accept that a certain amount of clarity is needed on these issues as soon as possible? While, in the Statement, she said that the meeting of the European Council on Thursday and Friday would not be able to take final decisions on the matter, it would be of great advantage if it could give some sort of timetable for the process by which the matter could be taken forward.

Baroness Ashton of Upholland: My Lords, I cannot pre-empt the discussions that will take place at the European Council. Suffice to say that my right honourable friend the Prime Minister will make a Statement, as always after a European Council meeting. If noble Lords wish to hear that Statement—which I sincerely hope noble Lords do—it will be repeated by me next week.

Lord Rowlands: My Lords, will my noble friend assure the House that the Government will oppose most strongly any attempts to introduce some of the provisions of the treaty through non-treaty means?

Baroness Ashton of Upholland: My Lords, I will not pre-empt the discussions that will take place. I understand my noble friend's point that European Union members need to respect what has happened with the Irish vote, and therefore respect the implications for the treaty. I am sure, however, that they will want to discuss some of the issues; for example, the effectiveness of meetings, and so on. We will have to see what they come back with. My noble friend is right: as the treaty will not become law, anything requiring law to make sure that it happens will not happen.

Lord Lawson of Blaby: My Lords, is it not the case that what has happened is much more important than just one country deciding to be out of line? It is the one country that has consulted its people. That has immense significance. If noble Lords do not realise this, they do not begin to get at the problem. Remarkably, the people of Ireland voted against the clearly expressed wishes of all the major political parties in Ireland. It was very similar in France. I was in France a few years ago for the referendum on what was virtually the same treaty. Again, the French people voted "no". They, again, showed that they do not trust their leaders on this issue. There is a serious failure of trust. One way to begin to redeem that—and I know that this is a radical suggestion—would be for politicians around the Union to start telling people the truth. It is not being told at present.
	I give one example and ask the noble Baroness to comment on it. We have heard a lot about the treaty being necessary as a consequence of enlargement. Nobody could have been more in favour of the enlargement of the European Union than me, and it has been an enormous success. The idea that the constitution, or the Lisbon treaty, contains nothing more than what is necessary to cope with the enlargement of the Union is manifest nonsense. There are fundamental provisions in that treaty which have nothing to do with enlargement. That is the sort of thing that people do not like. Is it not the case that, if people are not told the truth, the European adventure is going to come to much harder times than it has already been through?

Baroness Ashton of Upholland: My Lords, the noble Lord went through a series of different issues there. The first was to do with whether the leadership should do more to talk about what the European Union is all about, and what the benefits of enlargement are. I agree with the noble Lord about that. There is a job to be done; it is something that I have been taken to task for, not least by the Liberal Democrats, many times over the course of debates. We need to make sure that people understand Europe better. I agree with the noble Lord.
	Then the noble Lord switched his argument to say that it is all about what is in the treaty, and that people do not realise what is hidden away. We have to assume that the Irish people, in making their decision, considered carefully what is in the treaty, and decided on that basis. It takes nothing away from the fact that in this country, in our parliamentary democracy, 1,300 legislators have had the opportunity to deliberate in great detail over what is in this treaty, and to reach a conclusion. Thus far, they have reached the conclusions.

Business

Baroness Royall of Blaisdon: My Lords, it has been agreed by the usual channels that immediately we have concluded the dinner break business we will recommence the Report stage of the Health and Social Care Bill. We will not adjourn at pleasure.

Scotland Act 1998 (Transfer of Functions to the Scottish Ministers etc.) Order 2008

Lord Davies of Oldham: rose to move, That the draft Scotland Act 1998 (Transfer of Functions to the Scottish Ministers etc.) Order 2008 laid before the House on 8 May be approved.

Lord Davies of Oldham: My Lords, the draft order before us today is made under Section 63 of the Scotland Act. Section 63 allows for the transfer to Scottish Ministers— that is, members of the Scottish Executive—of functions that are exercisable,
	"in or as regards Scotland".
	This is commonly known as executive devolution. Since 1999, 15 orders have been made under this section. These orders demonstrate the Government's pragmatic approach to devolution, and the flexibility contained within the Scotland Act. In certain circumstances there will be a case for functions to be exercised by the Scottish Ministers, where the subject matter remains the responsibility of this Parliament. Each case is examined on its merits to ensure that functions are exercised at the appropriate level.
	The primary purpose of the order is to ensure compliance with a European Community directive, specifically the directive on integrated pollution prevention and control. This introduced a requirement for an integrated means of controlling emissions from industrial installations to air, water and land across Europe. The directive requires member states to ensure that energy is being used efficiently in the operation of certain industrial installations. Some aspects of that requirement fall within the subject matter of the Energy Act 1976, and so are reserved matters under the Scotland Act.
	The functions being transferred under the order will enable Scottish Ministers to make regulations that allow the Scottish Environment Protection Agency to enforce this energy efficiency requirement. The bulk of the directive relates to devolved matters which are currently being enforced by the Scottish Environment Protection Agency on behalf of the Scottish Ministers. As such, it is only sensible that SEPA is able to enforce the energy efficiency requirements, alongside all the other elements of the directive, in Scotland. It would also be administratively cumbersome for businesses to deal with energy efficiency under separate regulations. This order will allow regulations to be made to cover all aspects of the directive by the Scottish Ministers.
	In order to operate an industrial installation falling within the scope of the directive, operators must obtain a pollution prevention control permit covering the devolved aspects from the Scottish Environment Protection Agency. Under the order, Scottish Ministers will be able to give SEPA the legal authority needed to add energy efficiency as a prescriptive condition in the pollution prevention and control permit. Allowing Scottish Ministers to exercise this narrow function in no way alters the legislative competence of the Scottish Parliament.
	I trust that the House will agree that the order is a sensible use of the powers in the Scotland Act and demonstrates the Government's commitment to using these powers in the best interests of the people of Scotland. Improving energy efficiency can help businesses to make significant savings in the long term and is an opportunity for them to help tackle the challenges presented by climate change. I beg to move.

Moved, That the draft order laid before the House on 8 May be approved. 20th report from the Joint Committee on Statutory Instruments.—(Lord Davies of Oldham.)

The Duke of Montrose: My Lords, I thank the Minister for his explanation of the application of the order but I found it a little hard to follow. Certainly what he has said has helped me, but it was slightly complicated. The measure seems to focus largely on energy efficiency but to come under the integrated pollution prevention and control directive.
	I notice, too, that the order's application is directed at a community obligation—presumably it is the EU community—and that it states that the powers may be exercised concurrently by a Minister of the Crown. Again, if these activities involve Community obligations which apply at UK level and the Scottish Administration are found not to be fulfilling all the requirements, does the wording mean that if a Minister of the Crown wished to exercise powers he would have to go back to the Scottish Executive for something similar to a Sewel motion—the noble Lord, Lord Sewel is in his place—before proceeding? It is a question of how much power is devolved under this order and what the attitude of the Scottish Executive will be.
	Can the Minister give a further indication of where the measures are likely to apply? He said this was to do with emissions from factory chimneys and so on. Is that the only area in which the measures would apply? Are emissions from factory chimneys concerned with energy efficiency? I would have thought that pollution measures were less concerned with worries about energy and more to do with the pollutants escaping through chimneys.
	If the measure is to do with achieving energy efficiency, what will the effect be on the obligations put on energy supply companies and local authorities to finance energy efficiency measures in the domestic market? Will this mean that different criteria will be set up? Will this create more complications and separate obligations for companies operating north and south of the border?
	Is the aim of the order to assist the effectiveness of the Scottish Administration in producing adequate compliance with the Climate Change Bill even though the Scottish Executive have full powers over anything to do with that? Again, the UK is tied under an EU obligation and obviously we should do anything that can be done to assist the Scottish Executive to fulfil their part of it, even though they are solely responsible for how much they wish to fulfil.
	Is there any urgency in this measure and, if so, what? If the order is to do with energy efficiency, it seems a little strange to put this through now, when we are in the early stages of the Energy Bill in this House. Even though at present there is not much in the Bill that the order might affect, there is a strong lobby asking for the Energy Bill to include a feed-in tariff for independent generators. On a domestic scale, this could be seen as a form of energy efficiency. Perhaps the measure is solely directed at factory-level emissions, but it would be helpful to have a little more clarification.

Lord Maclennan of Rogart: My Lords, this is not a controversial measure. Indeed, it follows a number of precedents under the Pollution Prevention and Control Act 1999—so much so that the Minister mentioned 15 other orders which have preceded it. That in itself might raise the question of whether there is a case to be considered by the Calman commission for adjusting the relationship between this Parliament and the Scottish Parliament—this Government and the Scottish Government—in respect of some of the matters governing energy.
	While it is perfectly clear that energy efficiency is a reserved matter, it would not be sensible to divide the regulatory role within Scotland between SEPA and a United Kingdom regulatory authority. In light of the new authority of the integrated pollution prevention and control directive, this will remove a potential anomaly. I am conscious that if energy installations are potentially giving rise to pollution which the authorities have to consider in their regulatory role, it would be absurd to put them into the hands of another body south of the border in respect of one possible aspect of the installation.
	I welcome what is being done and thank the Minister for the clarity of his exposition.

Lord Sewel: My Lords, I welcome the order. It is an example of the kind of pragmatic, sensible extension of executive devolution that the Scotland Act both envisaged and facilitated. In saying that, surely this underlines and demonstrates the wisdom of the constitutional settlement that was established by the Scotland Act. Perhaps we would all be better off trying to work within that framework rather than trying to bring in new constitutional arrangements.

Lord Davies of Oldham: My Lords, I am grateful to my noble friend Lord Sewel and the Liberal Democrat Front Bench for the clear way in which they have illustrated that which I had rendered opaque in my opening statement. I am grateful to both noble Lord for answering most of the central points of the noble Duke, the Duke of Montrose. He is right in his obvious point that the order mixes up an energy issue with an environment issue. A great deal of the European order, which is to be carried out by member states, will be carried out by the Scottish Environment Protection Agency, which has powers to act in certain respects. In relation to the Energy Act 1976, some aspects are reserved to this Parliament, but we have always adopted a pragmatic approach to the issue of such reserved powers. Most reserved powers are central to the debate we had on the limits of devolution, but it was always recognised that for administrative reasons there might be areas where some flexibility would be necessary and for additional matters to be devolved by order to enhance the capacity of the Scottish Administration to carry out their proper obligations.
	The Scottish Administration have a certain range of powers and obligations that their environment protection agency intends to carry out. However, the Administration want to include within them certain areas that are under the Energy Act 1976 and are reserved but will, in administrative terms, be much better if they are specifically devolved to the Scottish Ministers for administrative efficiency. They raise no major issues of principle and powers.
	With the order, the Government are merely responding to a European order that, as the noble Duke, the Duke of Montrose, accurately identified, is predominantly concerned with the environment. We are seeking to devolve certain powers under the Energy Act that are otherwise reserved in order that the administrative operation can be more effective, from the point of view of both the Government of Scotland and business in Scotland, which will be responding to one agency regarding the obligations that it has to fulfil in controlling pollution. The noble Duke is right: this imposes an obligation upon industrial and commercial establishments with regard to effective control of their potential pollution. It does not have a great deal to do with the Climate Change Bill that has just gone through the House—except that I sometimes feel that everything is to do with climate change these days. The noble Duke was present often enough to know how wide-ranging that Bill was.
	This is a European directive concerned with the control of pollution, and we are seeking to create clarity for Scottish Ministers and Scottish business about the enforcement processes and understanding of what is required to be done.

The Duke of Montrose: My Lords, just to show the depth of my misunderstanding, as far as I can see, if the order is concerned with factory emissions, trying to clean up factory emissions and prevent emissions of certain substances actually decreases the energy efficiency. Does this measure allow the Scottish Executive to say, "We'll accept a certain decrease of efficiency so that we can say that we have improved pollution"?

Lord Davies of Oldham: My Lords, in so far as the Scottish Executive might be faced with that problem, so is the rest of the United Kingdom—and, as the directive applies across all European states, so are all those states. As the noble Duke knows only too well from his extensive work on the Climate Change Bill, there are costs to the control of pollution. If he is identifying that the order contains an element of potential detriment to Scottish business in terms of additional cost, I cannot deny that. However, if the United Kingdom Parliament retained the powers, the costs would still be borne. In fact, I fear they would be greater because there would be two administrative authorities dealing with the issue: the Scottish Ministers, who would have the powers that they exercise at present, and the British Government, with their powers under the Energy Act. The administrative costs would be greater as well, as would the complexity for the industries concerned. The noble Duke ought not to worry greatly about that.
	The introduction of energy efficiency measures might have short-term costs—they are bound to because of the cost of the installation of the necessary processes—but they bring long-term benefits. We all recognise, as we did with the Climate Change Bill, that improvements in energy efficiency benefit those who introduce them, and that those who do so early stand to benefit over those who are a little tardy. We ought not to entertain too many anxieties on that score, although I understand entirely the noble Duke's anxiety.
	I am a little less certain about the rather broader issues that the noble Lord, Lord Maclennan, brought in about the question of the Calman commission and its consideration of devolution. It is due to produce an interim report by the end of the year. Whether we are in a position to prejudge what it might say about the 15 orders—16 if this one, which introduces that element of flexibility, is passed by both Houses—and whether it will be critical of that process or laudatory and encouraging of it, is not for me to say from the limited position I occupy at the Dispatch Box on this order. However, I assure the noble Lord, Lord Maclennan, who as ever is well informed on these matters, that it is an issue that the Calman commission will certainly be considering.
	I hope I have assuaged the anxieties of the noble Duke, the Duke of Montrose, who as ever is zealous in his concern about the interests of—I give way to the noble Baroness.

Baroness Carnegy of Lour: My Lords, I did not mean to interrupt the Minister but I have a question for him, which I think is my right. The CBI welcomes the fact that energy is a reserved matter, because its members have businesses north and south of the border. In view of the costs that are implied in the order for firms in Scotland, have the Government consulted CBI Scotland on this order as well as the CBI south of the border, and what was its response?

Lord Davies of Oldham: My Lords, I cannot answer that directly, but I assure the noble Baroness that the moment the directive became enforceable upon all member states, the Governments of all member states addressed themselves to how to enforce the order. As a consequence this order does have costs, but it will have long-term benefits for industry and for wider society when it is implemented. The noble Baroness will recognise that the costs and benefits were going to be enjoyed by Scottish industry irrespective of which agency was the enforcer. All the order does is locate a greater amount of that enforcement in Scotland by the Scottish Environment Protection Agency, which has direct obligations under the directive for powers that it enjoys at present. All we are doing is enhancing SEPA's capacities at the expense of the central UK Government's responsibilities, because we are devolving that element of responsibility.
	Within that framework, therefore, it cannot be contended that Scotland looks on this order as disfavour—far from it. Scotland is gaining to its advantage administrative simplicity and straightforwardness in implementing an order which it would in any case have to follow even if it were imposed under parts of the Energy Act 1976 and the reserved powers of the UK Government.

Baroness Carnegy of Lour: My Lords, I appreciate what the Minister says, but where a firm operates north and south of the border it is being asked to consult two different bodies now. It is obvious that that will involve extra cost, and it may get different answers from the two bodies. I understand and note that the Minister said that no consultation with the CBI has taken place.

Lord Davies of Oldham: My Lords, I reassure the noble Baroness that we must not rush our fences. We are seeking by way of the order to devolve matters to Scotland, after which the Scottish Ministers will have to propose the regulations. How they propose and carry out those regulations is their business, but they would be naive in the extreme if they did not consult the Scottish CBI, as I am sure they will, because that consultation has taken place at the English level.

Lord Maclennan of Rogart: My Lords, if a company which operates both south and north of the border has to make application for planning regulations, it will have to subject itself to different regimens north and south of the border, will it not? That is implicit in operating in Scotland and England. That could be true also for energy, installation and pollution issues. However, if one body is in charge of those installation issues in Scotland, it cannot make sense to fragment the responsibility for part of that installation in Scotland and translate to two bodies the decision-making for a purely Scottish operation. This is an entirely sensible solution to that potential problem.

Lord Davies of Oldham: My Lords, I am grateful to the noble Lord for expressing it with greater clarity than I had done. He is absolutely right: that is the purpose behind the order, which is benign in intent. It seeks to give to Scotland a more orderly structure of implementation in circumstances where otherwise, because the energy part was not devolved, Scotland would be faced with implementation by its own Scottish Environmental Protection Agency and by an agency operating on behalf of the UK Government.
	I reassure the noble Baroness, Lady Carnegy, that when it comes to the Scottish dimension of enhancing these powers, the regulations are the responsibility of Scottish Ministers. Neither she nor I have the slightest doubt that they will consult the Scottish CBI and all others who have an interest in the matter, as we would ordinarily expect.

On Question, Motion agreed to.

Health and Social Care Bill

Consideration of amendments on Report resumed.
	Clause 2 [The Commission's functions]:

Baroness Thornton: moved Amendment No. 7:
	Clause 2, page 2, line 9, leave out subsections (3) to (5)

Baroness Thornton: My Lords, it will be convenient also to consider government Amendments Nos. 9, 12 and 14. I note Amendments Nos. 10, 11, and 53, tabled on behalf of the Joint Committee on Human Rights, which are also in this group. I have considered them carefully, but I shall wait until I hear the arguments behind them before responding.
	During Committee, we had a helpful discussion about what the commission's objectives should be and the importance of setting them out clearly at the start of the Bill. It also became clear that the drafting of the beginning of the Bill, in particular Clause 2, was perhaps not as accessible as it might be.
	I hope that all noble Lords will agree that the proposed changes allow more straightforward references to health and social care services and the people who use them, and that, together with the new clauses that I shall describe in more detail, they deliver a clear statement of the commission's core functions, objectives and matters to which it must have regard. I am pleased to confirm that the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission have welcomed the amendments.
	I believe that we all agree that the primary purpose of the commission is to protect the interests of those who use both health and social care services. Government Amendment No. 9 therefore proposes an objective for the commission to reflect this. It gives the new commission a clear, succinct focus on service users. As reported in the Guardian last Wednesday, it will,
	"make outcomes for service users the top priority".
	Importantly, it clearly refers to social care as well as health. I hope that this will reassure noble Lords that the Care Quality Commission will protect and promote the health, safety and welfare of users of social care as well as healthcare, as has always been our intention.
	Amendment No. 9 also gives greater prominence to the three outcomes that the commission should help deliver through carrying out its functions; namely, improvements in the services that people receive; delivery in a way that focuses on the needs and experiences of the people who use services; and encouraging the best use of resources. Again, these clearly extend to both healthcare and social care users.
	There are of course other issues to which the commission will need to have regard. I listened carefully to the debate about whether we had included the right issues and expressed them in the right way. I hope that noble Lords will agree that we have reflected in government Amendment No. 12 the concerns that we heard in Committee. It sets out in a new clause the matters to which the commission must have regard.
	In particular, there was a strong feeling that the Bill should set out more explicitly how the commission will engage with local involvement networks. I will say more about the importance of effective engagement in our debate on a later group of amendments, but I take this opportunity to highlight that we have listened to noble Lords' concerns about LINks and therefore placed them at the start of the Bill by including in Amendment No. 12 a reference to the commission having regard to LINks as well as to other people.
	Concern was felt that the commission should support the rights of all people who use services, not just those of children and vulnerable adults. Amendment No. 12, therefore, requires the commission also to consider the rights of all those who use services, with specific reference to those detained under the Mental Health Act or deprived of their liberty under the Mental Capacity Act.
	As discussed in Committee, not all providers are public authorities for the purposes of the Human Rights Act. The amendment, in contrast, emphasises the importance of protecting and promoting the rights—in their broadest sense—that we all have. We should also remember that, as we have previously committed, the regulatory regime should reflect the principles of the European Convention. This demonstrates the importance that we place on this issue, although I know the noble Lord, Lord Dubs, has tabled amendments to include additional references to rights in the commission's objectives and I look forward to hearing what the mover has to say.
	Government Amendments Nos. 7 and 14 are simply technical amendments that streamline the first few crucial clauses and ensure that the definition of health and social care services is the same throughout Chapter 1. I hope that this demonstrates that the Government share the aspiration of noble Lords for the new commission to have a clear objective, focusing on both health and social care, and that the key issues raised in debate are now reflected in the issues to which the commission must have regard. I therefore urge noble Lords to support the amendments. I beg to move.

Baroness Cumberlege: My Lords, it is very difficult to get this right without sounding like a creep and being patronising, but I want to thank Ministers for the consideration that they have given to this Bill—it is about 300 amendments that we have collectively put forward.
	The noble Baroness, Lady Howarth, described the eight days in Grand Committee as group work. She is right. There is something deliciously awful about being banged up in the Moses Room for eight days, but it brought us together and engendered great respect between us. In addition, we have had our rewards, which would not have been possible if we had not had such responsive and thoughtful Ministers.
	I am delighted to see the group of amendments proposed by the Minister as well as the new clause, "Statement on user involvement", which follows in the next group. I think that this Bill was unwanted and unloved in its conception. It has been hard to find a group in the country that supports it. Usually with legislation there are a few champions, but apart from the architect, the noble Lord, Lord Warner, it has been hard to unearth them. However, because of how Ministers have conducted the Bill, many of the most recent briefings I have received start with the word "Welcome". The warmest welcomes have come for the objectives set out in these amendments.
	It is very difficult to understand the resistance that there was in the other place. That may be because they do not have the right Ministers—it may be because they see amendments as a challenge to their virility. We, on the other hand, are past it, so I suppose we do not fight in quite the same way. I think that these objectives and the matters for which the commission must have regard are about right. I could quibble with one or two words, but I think that that would be churlish. I congratulate the wordsmiths who have fashioned such a good result. They have encapsulated most of what we have sought. I am pleased to see retained in subsection (1)(e) of the proposed new clause in Amendment No. 12 that the concept of action by the commission should be "proportionate to the risks" involved, and that it should target its actions only where there is need.
	I notice in new subsection (2) that:
	"In performing its functions the Commission must also have regard to such aspects of government policy as the Secretary of State may direct".
	I fought that battle. I have lost it, and now I gracefully retire. I am not disappointed. I think that the gains we have acquired through the Committee stage outweigh the losses. I support the amendment.

Lord Campbell-Savours: My Lords, I want to say a few words on proposed new sub subsection (1)(e) referred to by the noble Baroness, Lady Cumberlege. What I have to say arises out of a conversation I had with a provider. Paragraph (e) says,
	"the need to ensure that action by the Commission in relation to health and social care services is proportionate to the risks against which it would afford safeguards and is targeted only where it is needed".
	"Where it is needed" is the judgment of the commission. It was put to me that that might be the peg on which someone who felt they were being unreasonably targeted might want to bring legal action against the commission, which would defeat, as I understand it, the purposes of the Bill. If they were targeted and felt penalised, they would argue with the commission, "You are acting unfairly and unreasonably". Do the Government feel that that wording is somehow insulated from the possibility of any legal action?

Baroness Masham of Ilton: My Lords, I am very concerned that prison health is not mentioned in the Government's bundle of amendments. The NHS is now responsible for prison health. This is very important. One of my concerns is that many people in prison have mental health problems, and some of the most complicated problems are those prisoners with a dual diagnoses—mental health and addictions. The rise in infections such as hepatitis is also of concern.
	We have some very large prisons. Prisoners may fall through the net of care. If the need for inspection of health and social care is not written in this Bill for prisons, it may well be neglected by the commission, which will have an enormous amount to do across the country and in many institutions. The commission might think that prisoners are behind closed doors and are not a priority. That would be totally wrong. Prisoners come in and out as though on a conveyer-belt. Society needs protection and ill prisoners need good health and welfare systems inside and on release from prison.
	I would like health and social care, including mental health, included in the new clause in Amendment No. 12, "Matters to which the Commission must have regard". I hope that the noble Lord, Lord Darzi of Denham, will visit a few prisons and discuss the health needs of these institutions. With the reduction of resources by 40 per cent and reduced inspections by the CQC, I feel worried that prisons may be neglected and forgotten about.

Baroness Stern: My Lords, I would like to respond to the invitation from the Minister to speak to Amendments Nos. 10, 11, and the consequential—

Lord Brougham and Vaux: After I have put Amendments Nos. 7 and 8 and moved on to Amendment No. 9 the noble Baroness can speak to her amendments, but she cannot speak to them at the moment. The noble Baroness wants to speak to Amendments Nos. 10 and 11, which are amendments to Amendment No. 9. I have not put Amendment No. 9, so she cannot do so yet. I want to put Amendment No. 7 first, then move on to Amendment No. 9, and then call Amendments Nos. 10 and 11 in the name of the noble Baroness, Lady Stern. To be in order, the noble Baroness, Lady Stern, cannot speak to her Amendment No. 10 as an amendment to Amendment No. 9 because Amendment No. 9 has not been called. I want first to get rid of Amendment No. 7.

Baroness Masham of Ilton: My Lords, are they not in the same group?

Lord Brougham and Vaux: My Lords, Amendment No. 9 has not been spoken to, so I cannot call Amendments Nos. 10 and ll. Perhaps I may put Amendment No. 7.

On Question, amendment agreed to.
	[Amendment No. 8 not moved.]

Baroness Thornton: moved Amendment No. 9:
	After Clause 2, insert the following new Clause—
	"The Commission's objectives
	(1) The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.
	(2) The Commission is to perform its functions for the general purpose of encouraging—
	(a) the improvement of health and social care services,(b) the provision of health and social care services in a way that focuses on the needs and experiences of people who use those services, and(c) the efficient and effective use of resources in the provision of health and social care services.
	(3) In this Chapter "health and social care services" means the services to which the Commission's functions relate."

Baroness Thornton: My Lords, I beg to move.

Baroness Stern: moved, as an amendment to Amendment No. 9, Amendment No. 10:
	After Clause 2, line 4, after "safety" insert ", rights"

Baroness Stern: My Lords, I apologise if I misunderstood the position. I would like to respond to the Minister on behalf of the noble Earl, Lord Onslow, the noble Lord, Lord Dubs, and myself and speak to Amendments Nos. 10, 11, and Amendment No. 53, which is consequential. These amendments are not agreed by the Joint Committee on Human Rights; they arise as a result of the Government's response to earlier committee proposals and are totally in accord with the thinking of the Joint Committee on Human Rights on the Bill.
	Amendments Nos. 10 and 11 amend government Amendment No. 9. They put a reference to "rights" in the objectives of the commission. Amendment No. 53 is grouped with them. It is a definitional clause that defines "rights" as inclusive of the,
	"rights protected by the Human Rights Act 1998".
	I warmly welcome the Government's amendments in the group. In Committee, it was clear that there was considerable support for ensuring that health and social care delivery had to be within a human rights framework, which really means nothing more demanding than that every human being should be treated as an individual with dignity and respect. We heard many examples in Committee of reasons why this should be taken more seriously, particularly from the noble Lord, Lord Campbell-Savours.
	The Government listened to that and have tabled Amendment No. 9. We, together with a range of other bodies, warmly welcome the Government's amendments in the group, and I echo the words of the noble Baroness, Lady Cumberlege, about how the Government have responded to the points we made.
	These amendments propose that the CQC's main objective should include a requirement to protect and promote rights. Currently, the main objective is limited to the protection and promotion of health, safety and welfare, and that the CQC should perform its functions for the general purpose of encouraging,
	"the provision of health and social care services in a way that focuses on the"
	"rights" of service users, rather than the government amendment which is limited to encouraging a focus,
	"on the needs and experiences"
	of users. We have included the definitional clause, proposed in Committee, to define "rights" as inclusive of
	"human rights protected by the Human Rights Act 1998".
	The amendments to which I am speaking today seek to go a little further than the Government have done. We suggest that this very welcome inclusion of rights should not just appear in matters that the commission should have regard to but should appear also in its objectives. The very helpful briefing I have had from Help the Aged supports the view that the commission should have a clear remit to,
	"place human rights principles at the core of its work".
	The amendments propose that part of the main objective should include a requirement to protect and promote rights. Will the Minister explain why the Government consider that the protection and promotion of the rights of service users should be less important for the commission than the protection and promotion of safety or welfare? Do the Government accept that it should be part of the commission's ethos to encourage regulated service providers to provide their services in a way which protects and promotes the rights of service users? If the noble Baroness agrees, why was it not possible to include an express reference in the Bill under the provision on objectives? I should be grateful if the Minister could share her thinking on these questions with the House so that we can be clear why the stronger position originally advocated by the Joint Committee on Human Rights has not found favour with the Government. I beg to move.

Baroness Barker: My Lords, I wish to address an issue in Amendment No. 10. In doing so, I thank the Minister for the work that she has done to bring forward the set of amendments which I believe she has now passed and which are now part of the Bill. Not only has she dealt with this matter and the House in a fair and exemplary manner, but the legislation is a great deal stronger as a result. I congratulate her and the Bill team.
	I am in something of a dilemma as regards Amendments Nos. 10 and 11. I was fully in favour of Amendment No. 10 and could not see what objection the Government could have to it because the word "rights" is far more inclusive than the concept of safety. For example, "rights" would include a patient's right to expect that their safety would be taken into consideration by providers of services. Were I a government draftsman, I should be delighted to have a much wider and looser concept with which to deal, and, on balance, I still feel that way. However, I have a slight dilemma as regards the amendment of the noble Baroness, Lady Stern, which refers to rights but not to human rights. People who need social care have very few legal rights. For example, there is no right to receive services. However, as human beings they have an expectation that their human rights will be regarded.
	On the issue of safety, the noble Baroness, Lady Stern, is doing the Government a favour by proposing an alternative wording and I encourage the Minister to look at that seriously. I refer to double effect. Some medical treatments can have serious adverse consequences for some patients. Doctors may recommend those treatments because they believe it is in the best interest of a patient to do so even though they know that there may be adverse consequences. In doing so they might compromise, or pose a threat to, the safety of a patient. They take a calculated risk for a beneficial reason. This is slightly complicated but, were I in the Government's shoes, I would prefer to have a measure which did not mention safety. On balance I support the approach taken by the noble Baroness, Lady Stern, but I would prefer the measure to refer to human rights rather than just to rights. However, I believe that she is on the right track and is offering the Government something which they would be very wise to accept.

Baroness Meacher: My Lords, I had not intended to speak to this amendment but I wish to support the amendment of my noble friend Lady Stern. Working with the Healthcare Commission year by year, I am very conscious that we are required to meet all sorts of standards in relation to safety, care planning and all sorts of procedures, processes, systems and risk management. There are rafts and rafts of standards. When I go round our services—I shall not comment on all the services within my east London mental health trust—I question whether all these standards of the Healthcare Commission have any impact at all on the very personal experience of our service users and patients. For example, respect and dignity are very sensitive and personal issues. If one has in these objectives the right to dignity and respect, that may ensure that the CQC homes in on some of these very sensitive and personal rights which the regulation of systems and processes may not touch. I leave that thought with Ministers.

Earl Howe: My Lords, it would be wrong if I did not add my few words of thanks to those of my noble friend Lady Cumberlege to the noble Baroness, Lady Thornton, and the noble Lord, Lord Darzi, for having listened so carefully to the issues we raised in Grand Committee, and for having responded so constructively to them.
	I particularly welcome Amendments Nos. 9 and 12, and not least the fact that we will now have LINks mentioned in the Bill. I am also glad to see "experiences", in relation to the experiences of patients and service users, substituted for "satisfaction". It is a more neutral term which is more conducive to the effective measurement of the quality of services. I congratulate the Minister on having reconfigured this part of the Bill in a way that reads a lot better than the original did. We have the objectives and the matters to which the commission must have regard. The way that the clauses flow from one another is a lot better and easier to understand. I for one am glad to see these amendments included in the Bill.

Baroness Howarth of Breckland: My Lords, I support the amendment of the noble Baroness, Lady Stern. I have seen services that offer supreme care but care that is patronising and rather overweening. I have seen care where there has been attention to detail but not to the individual. If we were to include the word "rights" as well as "safety", we would have to pay attention to personalisation and dignity in residential care, as the noble Baroness, Lady Meacher, pointed out. It would make that subtle difference where care is good but not necessarily personalised and directed to ensure that each individual has that care. While I am on my feet, I add my thanks. It is an exceptional piece of legislation that includes a listening to users provision. The Government are to be congratulated on that if not on all the other clauses.

Baroness Thornton: My Lords, I thank my noble friend Lord Dubs and the noble Earl and noble Baroness for their contributions on Amendments Nos. 10 and 11. We are addressing those amendments, but I shall respond to some of the other points made. On behalf of myself and my noble friend I thank noble Lords for the warm welcome that they have given to our amendments.
	I remain convinced that our amendment represents a more appropriate reflection of the commission's responsibilities. I shall take this opportunity to explain and address some of the points that were raised. We have responded to the concern expressed in Committee that the Bill should say more on the issue of rights by introducing a broader requirement for the commission to have regard to the need to protect and promote the rights of all those who use health and social care services. As I said in my opening remarks, we should also remember the context, which is that the regulatory regime will reflect the principles of the European convention. As I set out earlier, this includes, but is not limited to, human rights and that is why we do not believe that Amendment No. 53 is required.
	Our amendment, as drafted, is appropriate for a body of this type. After all, as I have said before, the commission will be one of a number of bodies with responsibilities in this area. So, while it is important that human rights should inform the commission's approach and its thinking, its primary objective must be to protect the health, safety and welfare of people receiving services. Neither would it be appropriate to include rights among the outcomes the commission should be expected to focus on in carrying out its functions.
	I turn to the point made by my noble friend Lord Campbell-Savours about legal action being brought against the CQC. The Bill contains provisions for those with action being taken against them to make representations to the CQC before action is taken; for example, in Clause 23 on the right to make representations. We would not anticipate that legal action would be necessary if a care home felt that it was being targeted disproportionately.

Lord Campbell-Savours: My Lords, my noble friend did not say that it was not possible. I was seeking to find out whether it could be used as a peg for bringing legal action.

Baroness Thornton: My Lords, I did not say it was possible; you would have to completely disregard the proportionality, which is already included in the Bill, to do that. It would be unlikely, and not likely to succeed either.
	The noble Baroness, Lady Stern, might be interested to know that the Equality and Human Rights Commission has also warmly welcomed the amendment, as drafted. The noble Baroness, Lady Masham, is a great champion of these issues, and she is right to be concerned. Later amendments on Crown application will ensure that the commission's registration functions can apply to the Prison Service. Our consultation proposed that that should be the case.

Baroness Masham of Ilton: My Lords, will it be written in?

Baroness Thornton: My Lords, it will not be written into this part of the Bill.
	We do not believe that it is appropriate to accept Amendments Nos. 10 and 11 and hope that the noble Baroness will not press them.

Baroness Hayman: My Lords, we are dealing with Amendment No. 10 as an amendment to Amendment No. 9, so it would helpful to know what the noble Baroness would like to do.

Baroness Stern: My Lords, I beg leave to withdraw the amendment.

Amendment No. 10, as an amendment to Amendment No. 9, by leave, withdrawn.
	On Question, Amendment No. 9 agreed to.
	[Amendment No. 11, as an amendment to Amendment No.9, not moved.]

Lord Darzi of Denham: moved Amendment No. 12:
	After Clause 2, insert the following new Clause—
	"Matters to which the Commission must have regard
	(1) In performing its functions the Commission must have regard to—
	(a) views expressed by or on behalf of members of the public about health and social care services,(b) experiences of people who use health and social care services and their families and friends,(c) views expressed by local involvement networks about the provision of health and social care services in their areas,(d) the need to protect and promote the rights of people who use health and social care services (including, in particular, the rights of children, of persons detained under the Mental Health Act 1983 (c. 20), of persons who are deprived of their liberty in accordance with the Mental Capacity Act 2005 (c. 9), and of other vulnerable adults),(e) the need to ensure that action by the Commission in relation to health and social care services is proportionate to the risks against which it would afford safeguards and is targeted only where it is needed,(f) any developments in approaches to regulatory action, and(g) best practice among persons performing functions comparable to those of the Commission (including the principles under which regulatory action should be transparent, accountable and consistent).
	(2) In performing its functions the Commission must also have regard to such aspects of government policy as the Secretary of State may direct.
	(3) In subsection (1)(c), "local involvement network" has the meaning given by section 222(2) of the Local Government and Public Involvement in Health Act 2007 (c. 28)."
	On Question, amendment agreed to.

Baroness Thornton: moved Amendment No. 13:
	After Clause 2, insert the following new Clause—
	"Statement on user involvement
	(1) The Commission must publish a statement describing how it proposes to—
	(a) promote awareness among service users and carers of its functions,(b) promote and engage in discussion with service users and carers about the provision of health and social care services and about the way in which the Commission exercises its functions,(c) ensure that proper regard is had to the views expressed by service users and carers, and(d) arrange for any of its functions to be exercised by, or with the assistance of, service users and carers.
	(2) The Commission may from time to time revise the statement and must publish any revised statement.
	(3) Before publishing the statement (or revised statement) the Commission must consult such persons as it considers appropriate.
	(4) In this section—
	(a) "service users" means people who use health or social care services, and(b) "carers" means people who care for service users as relatives or friends."

Baroness Thornton: My Lords, I ask noble Lords also to consider government Amendments Nos. 17, 18, 22, 23, 25, 26, 27, 35, 44, 45, 46, 47, 48, 49, 58 and 77.
	The importance of user involvement in the Care Quality Commission's work was another of the strong themes in our debates in Grand Committee and in the other place. We have been convinced from the outset that this must be a priority for the commission. However, a compelling case was made in Committee for the commission to have a more explicit duty to involve people who use services and their carers in its work.
	Again various models were put forward. Having considered the most appropriate way to proceed we are now bringing forward Amendment No. 13 which would require the Care Quality Commission to consult on and publish a document setting out how it plans to involve, engage and inform people who use its services—and crucially their carers and families—in its work. It is most appropriate for the commission itself to determine the precise way in which it engages with users and carers but there should be a clear indication in the Bill what user involvement must cover. In this way it will be able to build on and continue the current commission's good practice.
	Therefore, the new clause not only requires the commission to seek views about health and social care services itself, but also how it carries out its own functions. It also makes it clear that the commission can involve people in its work, for instance, as lay inspectors. The commission must have proper regard to views expressed by service users and carers. Transparency will be the key to ensuring that the commission is being effective in engaging people in its work. Crucially, government Amendment No. 46 will require the commission to set out in its annual reports to Parliament what it has done to implement the statement on user involvement.
	I am delighted to report that, in their briefing, the Picker Institute, Which? and the National Consumer Council strongly welcomed the Government's proposals, which they consider will pave the way for a regulator that actively consults and engages with people. Local involvement networks will now provide an important vehicle for involving people in health and social care services and I am sure they will have an important role in the work of the commission. I have already set out our proposals for requiring the commission to have regard to the views of LINks.
	To support this, Amendment No. 49 would amend the Local Government and Public Involvement in Health Act 2007 to require LINks to send their annual reports to the Care Quality Commission, as well as to the Secretary of State. This is obviously not intended to remove the need for the commission to actively engage with people through LINks and in other ways, but it will help to ensure that the commission is fully aware of local people's views on the services they receive across the country, and it reinforces our belief that LINks are a crucial means of ascertaining the views of users and carers.
	I move now to the amendments tabled in response to concerns expressed in Committee about independence from the Secretary of State, in relation to both the Care Quality Commission and the Council for Healthcare Regulatory Excellence. In relation to the Care Quality Commission, compared to the current commissions, the new regulator will have new freedoms to determine how aspects of the registration system will work, and a greater flexibility in the enforcement powers at its disposal to use against failing providers. To demonstrate that we are genuinely determined to afford the commission as much independence as is practically possible, Amendments Nos. 35, 44 and 47 would delete "or modified" in Clause 42, remove the power for the Secretary of State to specify when the commission must publish its proposed programme of reviews, investigations and studies under Clauses 44, 50 and 53, and amend Clause 81 to ensure that the commission is free to determine for itself how it makes and publishes its plans for charging fees.
	On professional regulation, Amendment No. 58 removes the Secretary of State's power of direction over the CHRE in Clause 111. Although this power was included in the Bill to allow the Secretary of State to help the CHRE prioritise its workload, I recognise that noble Lords felt that this could be perceived as undermining the independence of the CHRE. The department has discussed the idea of removing it from the Bill with the CHRE, and as a result of reassurances from the CHRE, I am now confident that it can safely be dispensed with. This group of amendments also contains a number of drafting, minor and technical amendments. I do not intend to go into detail on those, although I am happy to clarify any issues that noble Lords might raise. I beg to move.

Earl Howe: My Lords, I have no hesitation in saying that in this cluster of amendments there is one rather large diamond in the shape of Amendment No. 13, which I warmly welcome, as well as a number of little gems. I am thinking particularly of Amendment Nos. 35, 44, 47 and 58, all of which, in their own ways, remove some of the concerns we had in Committee about the potential for the department and Ministers to influence the commission and the Council for Healthcare Regulatory Excellence. I am grateful to the Minister for having gone to the care that she has in looking at the points that we raised and I congratulate her on Amendment No. 25, which refers to a deceased registered proprietor. A number of us had some unease about the way in which that part of the Bill was worded. I am sure that it will now be better for that amendment, so I warmly welcome this group.

Baroness Pitkeathley: My Lords, I too welcome this group of amendments, showing, as they do, the Government's commitment to user involvement. I want particularly to speak in very warm support of the mention of carers in Amendment No. 13. One of the key concerns about the Bill was the original lack of requirement on the commission to involve and consult carers during the course of its work, alongside service users and patients. Carers' lives are influenced to a considerable degree by the quality, accessibility and affordability of care services. Social care policy is finally recognising—through, for example, the Putting People First concordat and the National Strategy for Carers, the latest version of which was launched by the Prime Minister last week—that carers should be seen as partners in care and consulted and involved more by service providers. It was therefore essential that the Bill reflected these developments. These amendments will provide more recognition for carers and more recognition of the fact that most social care is provided not by any agency that is subject to inspection, but by family, friends and neighbours.

Lord Campbell-Savours: My Lords, I want briefly to intervene and make a suggestion. The statement on user involvement states:
	"The Commission must publish a statement describing how it proposes to—
	(a) promote awareness among service users and carers of its functions".
	In Committee, I laboured the point regarding my personal experience. I would like to suggest to the Care Quality Commission as it begins its work that it should require homes to publish on their websites information about the existence of the commission's reports and, if I had my way, actually to publish the reports. Most people, despite what other people think, do not even know of the existence of the current inspectorate arrangements prior to putting their relatives in homes. They find out about that pretty quickly when they are told about it, but very often they do not know in advance. I want a mechanism to inform people in advance, when they are looking at the glossies, that there is a report that they should read.

Baroness Masham of Ilton: My Lords, I, too, welcome the amendment, but will the service users or carers be able to state their concerns when there are not enough facilities? For example, there is the problem of intensive care costs, which was highlighted in the headlines of the Evening Standard today.

Baroness Thornton: My Lords, all I really need to say is that we are grateful for the thanks that have been expressed for these amendments. They would not have been possible without the fantastically expert Members of the Grand Committee who we were surrounded by and who know more than it is possible to say. My noble friend Lord Campbell-Savours had some wise words and helpful suggestions. I am very happy to say that we can now direct them to the chair of the CQC. I shall come back to the noble Baroness, Lady Masham, because I do not know the answer to her question at the moment.

On Question, amendment agreed to.

Lord Darzi of Denham: moved Amendment No. 14:
	After Clause 3, insert the following new Clause—
	"Meaning of "health and social care services" in Chapter 1
	In this Chapter "health and social care services" has the meaning given by section (The Commission's objectives)(3)."
	On Question, amendment agreed to.
	Clause 4 ["Regulated activity"]:

Earl Howe: moved Amendment No. 15:
	Clause 4, page 3, line 4, leave out paragraph (b)

Earl Howe: My Lords, I felt it right, following our debates in Grand Committee on whether Clause 2 should stand part of the Bill, to bring us back to an issue of fundamental principle regarding what the remit of the new commission should be. I am extremely worried that the decision taken in 2005 to split CSCI and to hive off the regulation of children's social care to Ofsted was a mistake. It was a mistake that originated from two causes—a determination by the current Prime Minister, then Chancellor of the Exchequer, to slash the headline costs of regulation by merging regulators; and a conviction that was allowed to take hold in the minds of Ministers and officials that, because Ofsted concerned itself with schools and children, a takeover by Ofsted of the regulation of children's social services would somehow be a natural fit. Neither consideration was a sound basis on which to dismember CSCI as the body regulating social care across the piece.
	We need to remind ourselves that the Department of Health's review of arm's-length bodies, published in July 2004, contained no proposal to split CSCI or to merge it with anything else. Indeed, the review explicitly set its face against such a course. It stated that any merger with the Healthcare Commission at this time would be,
	"a distraction from the heavy agenda of both sides and would impact on the ability of both to regulate providers and thereby protect patients and service users".
	That sensible conclusion was overridden the next year in the then Chancellor's Budget speech. The legislation integrating children's social services with Ofsted was taken through Parliament despite the misgivings of many who have a close knowledge of social care matters, such as the noble Baroness, Lady Howarth. We are seeing now the fruits of that policy.
	The Children, Schools and Families Select Committee in another place heard evidence a few weeks ago from the NSPCC and the British Association for Adoption and Fostering. They individually voiced their views that Ofsted is straining to meet the health and mental health care needs of children in care. It is not just the wisdom of hindsight that prompts me to say that this could have been predicted. At the heart of Ofsted is a mismatch. The methodology of Ofsted and the methodology of CSCI are completely different. One relies heavily on a tick-box approach, scoring schools on the basis of facts and statistics. The other depends critically on human interaction: physically inspecting premises, talking to staff and to service users and making value judgments about the quality of the service being delivered. In the end, an assessment of social care focuses on the competence and personal qualities of staff and the happiness of those whom they look after. I have absolutely no doubt that the senior management of Ofsted has undertaken its enlarged responsibilities with seriousness and assiduousness, but the task of assessing the quality of a school is 10 leagues removed from the task of assessing the well-being of vulnerable and sometimes damaged children in a care setting, where mental health needs and physical health needs must always be a concern.
	The merger of CSCI with the Healthcare Commission, which this Bill will bring about, would have provided a much sounder basis for the regulation of children's services than the merger which actually occurred. There are, potentially, excellent synergies between the regulation of children's services and the regulation of healthcare and care delivered under the Mental Health Act, but those synergies are now out of reach unless, somehow, it is possible for the Government to take stock of the situation which they have created and think again about it. Let us forget, for the time being, about the rationale cited for the dismemberment of CSCI in 2005 and concentrate on what is happening now. Is Ofsted succeeding in delivering the kind of regulation of children's services needed to give us all confidence that standards are being properly maintained? We need an honest appraisal of that question. If the answer indicates that it would be desirable to reintegrate the regulation of children's social care with that of adult social care under the umbrella of the CQC then, despite all the criticism I have ever voiced about repeated organisations of regulators, we on this side of the House would not stand in the way of such a change. I beg to move.

Baroness Tonge: My Lords, I would like to speak very briefly. It is unusual for me to disagree with the noble Earl, Lord Howe. I am looking back to long ago when I was a chair of social services in a London borough. I was always concerned about the buck-passing that used to go on between education services and social services for children. It was very difficult for the two disciplines to work together. I am also worried that the Care Quality Commission is covering so much. As you know, I have accepted now what the Government are doing, but I still think that it has an enormous brief and I just do not know how it is ever going to have enough staff. The thought that children's services may be in there somewhere and may get lost worries me because it is one of the crucial areas that we need to keep track of in this country.
	I felt pleasure that Ofsted was going to cover education and social services for children because that would bring things together. If the noble Earl feels that Ofsted may not be well equipped to cover children's social services in the way it does education—I am quite sure he is right—we should strengthen Ofsted and make sure that it really is able to cover them, and that children's services can be integrated and looked at by one inspectorate. That is a much healthier way to be than to have them separate.

Baroness Howarth of Breckland: My Lords, the noble Earl, Lord Howe, has put the argument about the difficulty of inspecting schools and children's homes by the same methodology very eloquently. The methodology that Ofsted uses fills four boxes and in those boxes you either pass or fail, rather like school exams. In a children's home, you cannot pass or fail; you have to be helped to reach the standard, which is that the children are going to be properly cared for holistically. Simply closing the home down—which is what happens if you are actually on the lower end of adequate—or not taking any more children into that establishment is unthinkable.
	I have personal experience of Ofsted refusing to allow young people to be taken into an establishment until it was brought up to another level, although the establishment was going to continue to operate. Those difficulties put the whole establishment at risk because of economic viability. Fortunately, it brought itself up to standard, as one would expect.
	I agree with the noble Baroness about the integration of services. We have reached this point; as we have said several times this evening, we are where we are. It breaks my heart to disagree with the noble Earl, Lord Howe; he knows that I am a huge admirer of him. Those services now on the ground are becoming integrated in terms of service delivery in schools and local authorities. That does not mean that you cannot change the method of inspection. That is the core of the problem—that Ofsted believes that it has an answer. Just as social care could learn from the methodology of Ofsted, because it has rigour, Ofsted too could learn about the holistic approach to services that are looking after children in terms of body, mind and soul. That is the less important message that I want the Minister to take away. After all, I was the Member who was sent to see the chief inspector because I was so determined, during the debate, to try to prevent the break-up of this regulation. Now that it has happened, further reorganisation would be disruptive. We must press for a different methodology.

Lord Warner: My Lords, we have over here the small corner of ex-directors of social services.
	I have huge regard for the approach that the noble Earl, Lord Howe, takes in many areas, but in this respect I must part company with him. We have talked a lot about integration of services in relation to this Bill. I used to have to try to balance, in a tightly constrained budget, the needs of protecting children with the needs of a growing elderly population; that is not easy to do. There have always been real issues about whether we could benefit children by integrating their services across departments. If Ofsted is not doing the inspections in the way in which it should, we should take that up with Ofsted. We should get the inspection right and should not try to put the clock back and reintegrate children's services with adult social services. That would be a step backwards. The future of adult social care is much more related to integration and removing the barriers between adult social care and healthcare, particularly with an ever ageing population and many people with long-term chronic conditions. We do not want to go down this path but, if we do, and if we have concerns about the way in which Ofsted carries out inspections of children's services, children's social services and children's social care, the evidence should be provided and the Government should be asked to look at that.

Lord Darzi of Denham: My Lords, following the brief discussion on the interaction between Ofsted and the Care Quality Commission in Grand Committee, I appreciate the fact that the noble Earl, Lord Howe, has given me the opportunity, with Amendment No. 15, to explore how the Care Quality Commission's registration of care service providers will fit with Ofsted's parallel registration regime for providers of children's social care services under the Care Standards Act 2000. That is my understanding of the purpose of Amendment No. 15.
	Noble Lords will appreciate, as we have heard, that the regulation of children's social care is now the responsibility of Ofsted. However, the regulation of children's healthcare will remain with the healthcare regulator, the Care Quality Commission, in future. The purpose of Clause 4(2)(b) is to ensure that services are not regulated twice—by both Ofsted and the Care Quality Commission—by specifically excluding any services that are registered with Ofsted from the definition of "regulated activity". To ensure that certain types of vital care services cannot fall between the cracks and be excluded from registration with either regulator, the definition of social care in Clause 5 is not a definition of adult social care. For example, those domiciliary care agencies which cater only for children can be within the scope of registration within the Care Quality Commission, so long as they are not already required to register with Ofsted. Alternative forms of drafting could well have resulted in neither body being able to assure the safety and quality of these vital care services. I know this is of particular concern to the Commission for Social Care Inspection. Of course, the commission and Ofsted are required to co-operate with each other, through Schedule 4 of the Bill and Ofsted's parallel legislation, Schedule 13 of the Education and Inspections Act 2006.
	I thought that most of the discussion concerned Ofsted's qualitative functionality as a regulator. The noble Baroness, Lady Tonge, very eloquently described—and was supported by my noble friend Lord Warner—how Ofsted is able to focus on the wider interest of children and young people, allowing a comprehensive view to be taken across care, education and skills. I am also led to believe that Ofsted took experienced inspectors with a significant knowledge of the social care sector and the inspection framework that Ofsted adopted in 2007 and was identical to the one used by the Commission for Social Care Inspection. As my noble friend said, if that framework is not functioning—the noble Earl, Lord Howe, has concerns about that—I have no doubt that as we wait for the inquiry of the Select Committee on Health, we can look at the functionality of Ofsted in more depth. I hope that I have been able to explain the benefit of Clause 4 and that the amendment can now be withdrawn.

Earl Howe: My Lords, I am grateful to all noble Lords who have spoken and I recognise that we are where we are. This series of contributions has told me very politely that I am on the wrong track. I am very grateful for the politeness and the constructive comments.
	I shall go home tonight recognising that perhaps I am on the wrong track in seeking to reintegrate children's social care with adult social care. But if there is one issue that I think we agree on, it is that we need to make sure that children's social care is being regulated properly and that if Ofsted is in any way struggling to do the job, then it needs to have the right tools and support. I hope that this short debate has not been in vain in that sense and that Ministers will keep a watchful eye on what is happening in that sphere. For now, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.
	Clause 6 [Requirement to register as a service provider]:

Earl Howe: moved Amendment No. 16:
	Clause 6, page 3, line 35, at end insert—
	"( ) In this Part "a person" may include, in particular, an employment agency established to supply—
	(a) doctors, nurses or other healthcare workers to the National Health Service;(b) social workers to a local authority; or(c) nurses or other persons who may be employed by a service user to care for him in a private dwelling."

Earl Howe: My Lords, this amendment takes us to an issue which we have not previously debated at any length—the issue of employment agencies. The Department of Health's consultation document, which sets out a registration framework to complement the provisions of the Bill, proposes, as I read it, that nurses' agencies should cease to be regulated under the CQC. I seriously question the wisdom of this.
	At the moment, agencies supplying nurses are registered by CSCI and have been registered and inspected since 1957. It is my view that patient safety requires that regulation of these nurses' agencies should continue and that similar regulation should be introduced to agencies supplying doctors, social workers and other health professionals. The hospitals and care homes which hire agency staff have neither the expertise nor the time to carry out the appropriate background and qualification checks on temps when they suddenly find themselves desperately short of staff. Agencies must establish a pool of pre-checked staff and understand properly the complex needs of health and social care roles in order to assign staff safely. Without a validated register of agencies that can do this to recognised standards, hospitals and care homes will have no way of knowing that it is being done properly.
	The Government's proposal is that employment agencies dealing with permanent recruitment and agencies supplying temps should not be subject to registration by the CQC. The department argues that there is already adequate regulation under the Employment Agencies Act. However, under that Act there is no register of agencies able to supply healthcare staff to recognised standards. The regulatory provisions in the Act focus on worker rights rather than patient safety, and no routine inspection of the agencies takes place. Effectively, the inspectorate under the Employment Agencies Act does not know which all the agencies for healthcare staff are and does not check the sector expertise of those they do know. That is one area of concern.
	The other area relates to the regulation of organisations involved in arranging both care and nursing in people's own homes—domiciliary care agencies. As I understand it, the intention is that regulation of these agencies should continue. However, there is a signal omission in the consultation document that I should like to query with the Minister. Domiciliary care agencies, whether for nursing or care, consist of three types. First, there are agencies known as direct service providers, which deliver a fully managed care service, and most, I understand, are of this kind.
	The second kind is employment businesses—a term of art, I believe—which supply staff to work under the direction and control of the service user. This sort of agency is becoming less prevalent but is regulated by CSCI to the same standards as direct service providers. If these agencies supply nurses, they have to register with CSCI as nurses' agencies, even though they may be registered already under the Employment Agencies Act. However, the need for dual registration will cease under the current proposals.
	The third kind of agency is employment agencies that merely introduce care workers to service users, which then employ those individuals directly without the agency being involved in any way with the employment contract. Usually, the nurse or care worker will be employed under a series of fixed-term employments lasting two or three weeks and will live at the home of the service user. This type of agency comprises only a minority of domiciliary employment agencies but they are a significant minority. The key difference here is that the agency has no control over, or contract with, the worker during the time that he or she is employed by the service user. At present, these agencies are regulated by CSCI to a specially shortened set of standards which reflect that fact.
	The wording of the scope of registration in the consultation clearly includes the first two types of domiciliary care agency—that is, direct service providers and employment businesses—but it does not appear to encompass employment agencies at all. Indeed, there is no mention in the consultation of the kind of special arrangement that these agencies have in supplying staff to service users—a fact which indicates to me that the omission is a real one. Considerable numbers of people rely on the employment agency model to secure cost-effective and very flexible care. They also rely on a system of regulation which ensures that these agencies operate in a way that protects patients in an effective fashion.
	Although this is a somewhat technical area, it is important, and I should be grateful if the Minister could reassure me that he will look closely at the concerns that I have raised and re-examine the department's policy. There are some important question marks over the scope of regulation in the area of employment agencies and these need to be resolved. I beg to move.

Baroness Tonge: My Lords, first, I am delighted this time to support the noble Earl, Lord Howe, in Amendment No. 16. I am amazed that this had not occurred to me or anyone else in Committee. I suppose that we all made assumptions—I assumed that agencies employing staff used in health and social care would somehow be covered. I could not believe that that was not so. I support the noble Earl and look forward to hearing the Minister's response and his reassurance that the Bill covers what the amendment is intended to cover.

Baroness Howarth of Breckland: My Lords, the noble Earl has set out the case very clearly, but I wanted to follow through briefly on the area of accountability. The noble Earl said that some care homes or establishments might be too busy to make checks. Organisations that are accountable for running a service must have the time to carry out appropriate checks. That means that there is probably a double set of checks on the agency supplying the person, but also on those who are using the services. The noble Earl has put his finger on exactly the right point in the third category he mentions, where people are being supplied to individuals and there appears to be a real gap in regulation. That is exactly where there needs to be regulation.

Lord Darzi of Denham: My Lords, we have been consulting on which particular types of care services should be within the scope of registration with the Care Quality Commission. The consultation, which closes tomorrow, on 17 June, is particularly relevant to Amendment No. 16, because we are waiting until we have carefully considered the responses to the consultation before determining the range of agencies that will be regulated by the commission. I am grateful to the noble Earl for raising the issue and have no doubt that after receiving the responses tomorrow, we shall come back at Third Reading to address any gaps in the clauses.
	I shall make just a few points about definitions. The definition of "a person" in Part 1 may be a legal person—that is, an organisation or body—or, as I have been told, a natural person—that is, an individual. The Bill provides for the regulation of activities, and service providers will be required to register in respect of the activities listed in secondary legislation as "regulated activities". There is no reason why "a person" cannot be an employment agency.
	In our consultation on the framework for the registration of health and social care providers, we have proposed personal care and nursing care as regulated activities. Agencies which supply healthcare workers fall within the scope of the Care Quality Commission, even where they supply services to children, as those are not regulated by Ofsted.
	We propose that anyone providing personal care or nursing care in people's own homes—excluding, of course, relatives, friends or neighbours—should register with the commission. This therefore would include domiciliary care agencies. However, to avoid dual regulation, we propose that where workers are supplied to deliver personal or nursing care solely in settings where a person is already registered by the commission with regard to that activity, these types of agencies should not need to be registered. For example, where an agency supplies workers to a care home, the care home will already have to register and meet registration requirements. As I said earlier, we specifically asked about this in our consultation and we will consider the responses carefully before making a final decision.
	There is one other issue on proposed subsection (b) of the amendment. Qualified social workers employed by local authorities are regulated professionally by the General Social Care Council. Where a local authority provides a regulated activity, such as a local authority-run care home, it is intended that the care home that provides the accommodation, together with personal or nursing care, will be regulated, as I said earlier. Finally, in complying with the registration requirements, the provider will have to ensure that workers are safe and competent under proposed registration requirement No. 15 in our consultation document.
	As I promised earlier, if there is still a gap and if we are wiser after the consultation, I will look into this and bring forward any necessary amendments at Third Reading. I hope that the noble Earl will withdraw his amendment.

Earl Howe: My Lords, that was a very helpful reply from the Minister. Of course I understand that, at this point, before the consultation has finished, it is difficult for him to comment in detail on these issues. I am grateful to him for saying that he will look at the points that I have raised and I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.
	Clause 13 [Cancellation of registration]:

Lord Darzi of Denham: moved Amendments Nos. 17 and 18:
	Clause 13, page 6, line 14, at end insert—
	"(1A) The Commission must cancel the registration of a person under this Chapter as a manager in respect of a regulated activity if—
	(a) no-one is registered under this Chapter as a service provider in respect of the activity, or
	(b) the registration of a person under this Chapter as a service provider in respect of the activity ceases to be subject to a registered manager condition."
	Clause 13, page 6, line 21, leave out paragraph (d) and insert—
	"(d) any other offence which appears to the Commission to be relevant."
	On Question, amendments agreed to.
	Clause 16 [Regulation of regulated activities]:

Earl Howe: moved Amendment No. 19:
	Clause 16, page 8, line 11, at end insert "including, in particular, the handling of recommendations for remedial action arising out of such complaints or disputes"

Earl Howe: My Lords, I shall speak also to Amendment No. 73, which brings us to the important issue of complaints made by service users, and in particular by residents of care homes. We had a useful series of debates in Grand Committee on this subject. Clause 16 says that the Secretary of State may impose requirements in regulations that those delivering regulated activities will have to meet in order to be registered by the CQC. Among other things, the regulations may make provision,
	"as to the handling of complaints and disputes".
	In other words, as I understand this provision, a service provider would need to demonstrate that it had systems in place to enable service users to make a formal complaint, and systems that enabled the complaint to be looked into and resolved. I am more than happy with that idea. However, it does not go quite far enough.
	We need to know that the CQC will not simply look at whether an establishment has a complaints procedure, but that it will also make sure that, if a complaint is made and a finding or recommendation emerges from the subsequent investigation—whether by the ombudsman or the provider itself—the recommendation is acted upon in an appropriate, timely and fair manner. In other words, it is not just the handling of the complaint that matters, but the handling of what comes out of the complaint. That point is of particular importance for the reasons given in Grand Committee by the noble Baroness, Lady Finlay, and my noble friend Lord Onslow. They highlighted the risk that someone in a care home, or receiving care in their own home, might be frightened to complain, in case their complaint rebounded on them in a vindictive fashion. The noble Countess, Lady Mar, told us about the very disturbing experience of her mother.
	The way in which a provider handles the follow-up to a complaint is every bit as important as the way in which it handles the complaint. The CQC should concern itself with that as well. The noble Baroness, Lady Thornton, promised to circulate a flow chart showing how complaints in each type of care setting will be processed under the new system. However, I am not aware that she has yet done so. I look forward to receiving it, if that is still possible.
	The other unresolved concern in this area is covered by Amendment No. 73. Those who fund their own care in a care home are particularly vulnerable. If they are aggrieved, they will not be able to turn to the CQC. Nor will they be able to turn to the ombudsman. They are not covered by the Human Rights Act. Therefore, if they make a complaint and are to have it resolved properly, they are totally reliant on the integrity and honesty of the management of the home. In my view, the position is one that leaves this vulnerable group of individuals unacceptably exposed. Up to now, the Government's answer has been that self-funders are people who have entered into a private contractual arrangement. If they do not like the care they are getting, they can move. The noble Baroness, Lady Thornton, did not resort to saying that, but other Ministers have done so. When we hear that line of argument, we all share the same concern: it is a lawyer's answer. The fact is that many elderly people in care have neither the emotional strength nor the intellectual capacity to make a complaint, let alone carry it through to a conclusion, and to expect them to be able to exercise their legal rights by moving to another home is often equally unrealistic. They are unable to countenance even the thought of moving.
	These are often frail and vulnerable people who simply cannot cope with tasks that younger people take in their stride. I believe that there is a strong case for giving those people an avenue through which they or their family and friends could pursue a grievance if the care provider has not resolved it satisfactorily. It is not possible to think in terms of the CQC providing such an avenue because of the scope of its statutory remit. That is why I am suggesting that local authorities should act in this capacity. The local authority has a role in the case of all elderly vulnerable people in so far as it is obliged to carry out a statutory needs assessment for all such individuals on request. It has that role even if the person ends up by paying for all of his or her own care. I appreciate that there are significant resource implications that need to be thought through, but many self-funders will be living in homes which are also occupied by people whose care is commissioned and funded by the local authority. In respect of those homes, there is an argument for saying that it is in the interests of local authorities as responsible commissioners to become aware of areas of concern, however they arise and whoever it is that brings those concerns to their notice.
	I hope that the Minister will at least think carefully about this proposal. I for one believe that it is too important an issue to be left hanging in the air. If we can resolve it during the passage of this Bill, we should certainly do so. I beg to move.

Baroness Meacher: My Lords, I rise to support Amendments Nos. 19 and 73 and to speak to Amendment No. 20. My noble friend Lady Finlay has asked me to give her apologies to your Lordships' House. She has put her name to these amendments, but unfortunately she has an engagement arranged a year ago that she is unable to break.
	Amendment No. 19 envisages regulations providing for the CQC to ensure the implementation of recommendations coming out of complaints investigations. The noble Earl, Lord Howe, referred to this in relation to care homes. I want to say a few words about its relevance in relation to health trusts as well. I happen to be very well aware that health trusts can be relied on to undertake investigations into complaints; they could not get away with not doing that. But my experience of this is that they are far less reliable in terms of following up the recommendations coming out of those investigations, and yet without doubt it is those lessons which are far more important in fact than the investigations themselves. If you carry out the investigation and do nothing about the lessons, you will have achieved very little. In Committee I mentioned a particular case where a complaint had been made, an investigation undertaken and recommendations issued that a clozapine clinic should be established. In fact, nothing happened after that recommendation, with the net result that the patient contracted diabetes, which of course will affect him for the rest of his life. That is how serious it can be if these recommendations are not followed through with. They—not always, but often—throw up some serious issues.
	Considerable resources are devoted to these investigations. A lot of professionals' time is devoted to thinking through the ramifications and the lessons that need to be learnt. It is therefore incredibly cost-ineffective if this is not done. As the noble Earl, Lord Howe, mentioned in speaking to Clause 16, the regulations already make provision for the handling of complaints and disputes. All this amendment does is to make sure that this piece of complaint handling—the following up of recommendations—is not neglected. I find difficult to imagine that Ministers will not be more than happy to incorporate that small adjustment.
	I speak briefly to Amendment No. 73, which seeks to ensure that self-funders in care homes have access to an independent complaints procedure. The noble Earl, Lord Howe, has, as always, spoken eloquently on this. I make a couple of points. First, in discussing this, a number of us are concerned that we should not establish new bureaucracy, new procedures and elaborate new approaches. The idea of tacking the complaints process for self-funders on to existing local authority procedures is as cost-effective as you can make it. While the noble Earl, Lord Howe, suggested that this may be very expensive, my fear is that it could be rather inexpensive because, even if there is a relatively independent complaints process, such vulnerable self-funders in homes will be disinclined to make complaints, as will their relatives. Only in the most dramatic circumstances will such complaints be made. For that reason, it is important to have this facility. What about somebody who is, as it were, semi-starved? I happened to have a relative in such a situation some years ago. The idea that you cannot do anything about that because you feel so vulnerable, particularly if the complaints process is not independent, is a pretty appalling state of affairs in our society. That is one point: this is about as cost-effective as you can get it.
	Secondly, if Ministers are willing to accept this point, the regulations will need to make clear who can make such complaints. Tragically, the sort of people we are talking about will probably not be in a position to make the complaints themselves. Some of these people do not have any relatives to complain on their behalf. It may, indeed, be a CQC or LINk representative—or somebody of that kind—who sees something appalling happening and is the only person who can make a complaint on behalf of that resident. I put that concern on record.
	I go on to speak to Amendment No. 20, which makes provision for regulations to,
	"impose requirements as to the need to reduce health inequalities and discrimination on the basis of disability".
	It will also ensure that the CQC takes full account of the Disability Discrimination Act 1995. My perspective, as always, tends to be a mental health one, simply because that is where my experience lies. I have no doubt that this amendment has relevance to other groups of people with disabilities. Currently, people with severe mental illness die 10 years younger than the population at large. They are particularly at risk of contracting heart disease, hypertension, diabetes, breast cancer, respiratory problems and bowel cancer. I suggest that health trusts are failing on a massive scale to fulfil their duties under the Disability Discrimination Act.
	Unwittingly, general practices may also make it quite difficult for this group to receive the services that they need. Many people with severe mental illness require reasonable adjustments in order to gain access to services. For example, on a practical level, people who are taking sedative medication should not be required to telephone at 8 am to get an appointment. This is of some importance. Practices which fail to adapt their policies in this kind of practical way are probably creating health problems rather than helping with them. For example, some people will stop taking medication for their psychiatric disorder in order to ensure that they can get up in the morning and have their physical health dealt with.
	Why is there apparently so little special provision for people with mental health problems? When you consider that about one person in six experiences mental health problems at some time in their life, it is important to question whether GPs have anything like adequate training in mental health. If GP trainees do not opt for a psychiatry job during their senior house officer years, they can qualify with little or no real exposure to the range of serious mental illnesses from which many of their patients will suffer, or to the minor mental health disorders from which 30 per cent or so of their patients will suffer.
	In my experience, the physical care of patients in psychiatric hospitals has been badly neglected over the years. Some additional resources are finally now being devoted to this issue; they are certainly well overdue. Insufficient attention is still paid to problems such as obesity despite the fact that a great deal of psychotropic medication leads directly to increased weight unless great care is given to the issue. The health regulator should surely have a remit to require some progress to be made to reduce this gross inequality.
	In the early stages of the CQC's life it may have to focus on secondary health services rather than general practice and the proposed amendment allows for development over time. By leaving this issue to the realm of regulations we are avoiding imposing obligations on the Government which may prove impractical in the period immediately following the establishment of the CQC. I hope the Minister will see this as a fairly modest amendment but one of profound importance.

Baroness Barker: My Lords, I wish to make a point in relation to Amendment No. 73. The National Health Service and local authorities are often described as monolithic, lumbering entities, but they can move with the swiftness of a gazelle when they see a financial liability looming. It is important that whatever legislation we put in place is grounded in reality. For eight years the National Health Service and local authorities argued with all the power and might of Philadelphia lawyers to get out of the possible liability of NHS continuing care, and it is important that we recognise now that no local authority in its right mind would go near a self-funder and advise them if it thought there was the remotest possibility that in doing so it would somehow attract a liability for that person's care.
	It is incredibly important that self-funders have easy and swift access to some kind of support and I agree that it is preferable that that should be local to them. It is even more desirable that it is not a reactive service but a proactive one provided by people who come along and see someone, perhaps in a care home, whose capacity has perhaps declined since they first went in. If we want local authorities to do this, therefore, it is of the utmost importance that it is spelt out that they will not assume a liability for care by default; otherwise it will not happen. As the noble Earl, Lord Howe, said, at the moment local authorities have a statutory duty to assess, which they do not do in many cases. So they are not going to do this unless they are shielded from liability. That is my first point.
	My second point is that my former colleagues at Age Concern have noted during the progress of the Bill that the Government have talked about self-funders having access to an independent adjudicator if they have a complaint, but there is no detail about what the process will be, how people will access it and so on. We should have some detail about that. Notwithstanding the problems of the Human Rights Act and its inapplicability, it is important that we have some idea of how that will work and the timeframe for it. When the current investigatory powers of the Healthcare Commission are removed, that is one more element of protection that will be lost.
	The capacity of the health service ombudsman to deal with complaints is in question. I know that the ombudsman has gone before Select Committees in the other place and stated on record that there are no delays, but older people are still reporting considerable delays in having their cases taken up by the ombudsman. It is important that we have a timescale. Older people in care homes do not have long to hang about and get their complaints looked at because their average lifespan is very short.
	I thank the noble Earl, Lord Howe, for raising this matter again. We need to nail down those two issues to get something that will be at all workable.

Lord Campbell-Savours: My Lords, perhaps the noble Baroness has read something into the amendment that is not quite there. It does not say that the local authority would have one of its employees act as a person handling complaints. It simply says that a matter should be referred to a local authority. It would be quite possible for a local authority to have at its disposal a team of people acting voluntarily who would take on the responsibility of carrying out the task of dealing with complaints. There is not necessarily any expenditure implication for a local authority or body in this amendment, as I understand it; there is simply a responsibility for it to accept it. It can then deal with it in the way I have suggested.

Lord Low of Dalston: My Lords, I support Amendment No. 20, to which I have put my name. I shall speak briefly on it because time is getting on and the noble Baroness, Lady Meacher, has already moved it clearly and cogently.
	The absence of public health from the Bill has been noted intermittently in our debates. Anna Walker, the chief executive of the Healthcare Commission, has bemoaned the fact that the registration requirements explicitly say that the commission cannot bite on public health issues, so the CQC is dealing with healthcare rather than health. Amendment No. 20 offers a gentle but necessary correction to that tendency.
	As for disability discrimination, people exercising functions of a public nature are already prohibited from discriminating against disabled people under the Disability Discrimination Acts. The 1995 Act prohibits discrimination in the provision of goods and services, so Amendment No. 20 would not add a particularly onerous new burden on health authorities. It could, however, deal with some cases that are not covered by existing law. For example, it has been brought to my attention that people with mental health problems have particular difficulty when trying to volunteer in a health or social care setting. The Disability Discrimination Act would help to overcome that situation. Most importantly, it could enable the CQC to help providers to relate existing law and best practice to the daily reality of health and social care provision. The amendment would make things clearer and easier for both users and providers, and I am happy to support it.

Baroness Thornton: My Lords, we have had a number of useful debates about what requirements should be set under Clause 16. In Amendments Nos. 19, 20 and 73, the noble Earl, Lord Howe, the noble Baroness, Lady Meacher, and the noble Lord, Lord Low, have raised two issues that have attracted considerable debate: complaints, particularly the need for adequate arrangements for those who arrange their own care; and the importance of reducing health inequalities and discrimination.
	Perhaps I may respond first to Amendment No. 73. As the noble Earl, Lord Howe has made clear, the amendment is intended to fill a gap that exists when those who do not qualify for state support make a complaint about a service and feel that it has not been addressed appropriately.
	I remind noble Lords that anyone who has their care arranged by a local authority, even if they pay the full cost of that care, can refer a complaint to the Local Government Ombudsman. However, as I hope I made clear in Committee, we recognise that the fairness of current arrangements for those who arrange their own social care is an issue. We are talking to key stakeholders to agree a solution. We recognise the concern of the noble Earl, Lord Howe, and the noble Baroness, Lady Barker, who also raised the matter.
	However, I am afraid that I am not able to say anything more in detail about that, other than that we expect to be able to put forward proposals soon. I hope to be able to make a statement regarding independent adjudication within the timescale of the Bill. The noble Baroness, Lady Barker, was correct that this is a complex issue. Therefore I should perhaps also say that, given the complexity of the ongoing discussions, we would not be able to bring legislative changes forward in the scope of this Bill. I hope that, given that assurance that we take the issue very seriously, the noble Earl will feel able to withdraw this amendment.
	When we debated these matters in Committee, I believe that we all agreed that it is as important that action is taken to follow up and learn from complaints as it is that they are dealt with properly. Amendment No. 19 would ensure that regulations under Clause 16 included requirements about how recommendations following a complaint were taken on board.
	I described to the Committee requirement 10 in the registration requirements, on which we have consulted. It would require providers to ensure that there were simple, clear arrangements for handling complaints and disputes, and that complaints were investigated and resolved promptly and effectively. Crucially in light of our debate now, it would also require providers to ensure that learning from complaints was reflected in risk management, quality assurance, clinical governance and training and development arrangements. Learning would be informed by a variety of sources, but we would expect recommendations from the ombudsman and other key sources to play a vital role. The commission will be able to use the full range of its enforcement powers to take action where people fail to meet those requirements.
	I believe that we are in the same place here. However, I recognise concern that there should be a clearer indication in the Bill of the importance we place on this issue. I therefore undertake to consider Amendment No. 19 with a view to bringing back an amendment at Third Reading.
	I turn to Amendment No. 20. The noble Baroness was absolutely right about the need to tackle health inequalities, on which she spoke with her usual great eloquence, and to ensure that services provide comprehensive healthcare to people even when they have particular needs that require specialist support. As I said in Committee, we have been consulting on registration requirements which are particularly relevant. However, every requirement is relevant, which is why it will be important that the commission enforces them all with equal rigour.
	Amendment No. 20 seeks to address discrimination. I appreciate that it is driving at the ability of the commission to act in relation to a failure to implement the Disability Discrimination Act. The Bill already provides the commission with precisely such a power. It will be able to take action against a registered provider in relation not only to the requirements in this Bill but to those in other relevant legislation. I agree with the intention of the amendment, but there is no need to duplicate requirements that already exist in legislation. What we must provide for, as the Bill already requires, is that the commission is mindful of those requirements when it monitors services. In light of this, and my commitment to look again at Amendment No. 19, I hope that the noble Earl and the noble Baroness will agree not to press their amendments.

Earl Howe: My Lords, I very much welcome the Minister's reply on the issues raised by Amendment No. 19. I am grateful to her for saying that she will take the matter away and look at it again. That is great news.
	It was encouraging to hear the noble Baroness say that she is looking actively for a solution on self-funders, and that proposals are likely to emerge soon. It is a pity that she is not yet in a position to go further than that.
	We had some extremely useful contributions, notably from the noble Baronesses, Lady Meacher and Lady Barker. I completely take the point of the noble Baroness, Lady Barker, that local authorities would not wish to perform the function I propose if there is any possibility that they may acquire a liability for the complainant's care. I am not sure how that could come about but, if it is a risk, the contingency should certainly be avoided.
	The noble Lord, Lord Campbell-Savours, suggested an interesting way that the local authority might fulfil the function. I am grateful to him for that. Regrettably, this is not a matter that we will be able to take further this evening. I look forward to further discussions with the Minister, perhaps outside these four walls. For now, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.
	[Amendment No. 20 not moved.]

Lord Campbell-Savours: moved Amendment No. 21:
	Clause 16, page 8, line 16, leave out from "for" to end of line 21 and insert "—
	(a) the prevention and control of health care associated infections;(b) the safeguarding of individuals (whether receiving health or social care or otherwise) from the risk of any increased risk of being exposed to health care associated infections or of being made susceptible or more susceptible to them;(c) the displaying, in a place accessible to the public on the premises of the service provider, information relating to the incidence of health care associated infections, subject to the following provisions—(i) that the display of such information be in a location agreed by the Commission;(ii) that the information be made available in a form prescribed by regulations;(iii) that the information made available relates to each and every outbreak of such infection on the premises of the service provider in the previous six month period;(iv) that the information on health care associated infections provided under this paragraph shall be confined to those infections required to be published by the Secretary of State."

Lord Campbell-Savours: My Lords, I have been very brief on my last three interventions but will be longer on this one. This is the first of a series of amendments that fall under the general heading of transparency. I am hoping to move a number of similarly themed amendments on a number of other Bills. Some may appear controversial, but I am increasingly convinced that transparency plays a vital role in the exercise of influence over conduct in both public and private sectors.
	In overview, transparency is a powerful tool to be used in securing greater economy, efficiency, effectiveness and accountability in the control of enterprise and in the provision of public services. It conditions conduct. I believe that we have not even begun to consider the scale on which it can be applied and what are the consequences. That principle underscores my amendments to the Bill.
	Amendment No. 21 is based on my own observations over the years, both as a patient and as a visitor, of what happens in many hospitals. It also stems from my experience as an MP in the late 1990s in trying to extract information from my local area health authority on the incidence of MRSA in individual hospitals in Cumbria—not statistics on death but statistics on infection. The only statistics it was prepared to provide me with were trust-wide statistics, and the only way you could secure information about the incidence of infection in any particular institution at that time, or even ward, was through unofficial personal contacts, but of course that rendered the information gained as unusable.
	I am more than conscious of the many programmes that have been put in place to help reduce the incidence of hospital-acquired infections—the use of hand-washing facilities and gels, the deep clean programme, the designation of responsible officers, the wearing of disposable garments, pre-admission screening, and hospital-based uniform laundering services. I am equally aware of the Winchester approach and arrangements in Holland. The Winchester and Eastleigh healthcare NHS trust has been very successful in its campaign to eradicate MRSA. Its use of pre-assessment screening techniques; the requirement that the use of cannula be prescribed and then monitored daily; additional care over the use of catheters; and the emphasis on stricter standards of ward cleanliness have all contributed to the collapse in the incidence of MRSA in the hospital. There has been only one case in the past six months, and that was community-acquired.
	Contrast that with the sloppy conditions that remain in some hospitals and the casual approach that some hospital staff have to the need to secure the highest possible standards of cleanliness. For example, some hospital toilets and even bathroom facilities are filthy, even today. Some hospital ward floors are not kept constantly clean. Some nursing staff, thankfully a minority, allow standards of personal hygiene to slip. Some ward managers run a highly intensive use of hospital beds, resulting in an increased risk of contamination. Some consultants believe that they are somehow beyond the rules and do not always apply them to themselves and are rarely challenged by ward staff. Some hospitals are unable to enforce contractual agreements on cleaning due to managerial inadequacy. Some hospitals suffer from failure due to ward politics and personality conflict.
	I argue that applying principles of transparency could make a difference in the attitude of some staff and break down barriers to hygiene programme reforms where they exist. If you make a ward publicly accountable for its hospital-acquired infections by making statistics available in a public place, it will have a marked effect on attitudes to hygiene control within the ward. Wards would not want to be identified as at risk and ward managers, whether they be admin staff, matrons, sisters or whoever, would demand the highest possible standards and would challenge any activity which they felt would prejudice the inspection control integrity of their ward. Yes, it would cause ructions within hospital management structures. Yes, it would irritate a lot of people. Yes, it might even lead to ward boycott on occasions. But it would concentrate the mind of everyone involved in hospital care on the need to drive out infections. It would have a knock-on effect right up the line through to the national allocation of resources for this area of inspection control. It would unleash that backlash of public opinion which is often needed when major change is necessary and it would focus the minds of not only the movers and shakers in healthcare but the wider community on the need to stamp out this menace which now frightens millions of people in this country.
	I close by reminding noble Lords of the European tables on hospital-acquired infection, particularly as regards MRSA. I shall not go through them in detail but they show that the UK has the highest incidence. I believe that if my amendment became law and were implemented by the new commission, it would have a marked effect on the whole incidence of hospital-acquired infections. I beg to move.

Baroness Thornton: My Lords, I thank my noble friend Lord Campbell-Savours who outlined these very serious issues in his usual clear and moving way. I welcome the opportunity to say how important it is that we take strong action to tackle infections.
	Amendment No. 21 would restructure the existing provision in relation to infections to require the commission to require providers to display information on their premises about recent instances of infection. Let me say straight away how sympathetic I am towards my noble friend's intention with this amendment. It is, of course, crucial that such information is easily accessible to the public. I believe that this will be the case even without this amendment, but there is also scope for regulations under Clause 16 to include requirements along these lines. Although this issue is not covered in the current consultation, we will be consulting further later this year on the detail of what regulations under Clause 16 will cover.
	As noble Lords will be aware, these regulations will also include provision on managing infections and we will be revising the current code of practice on healthcare-associated infections, which will be used to determine compliance with those regulations, to apply to all regulated activities. Under the current code of practice, every NHS body is also required to have a director of infection prevention and control, who is required to make an annual statement on HCAIs in the organisation and to make this available to the public. In revising the code, we will consider how information on infections should be provided in all sectors. The revised code will be subject to a full public consultation so there will be an opportunity for people to comment on our proposals.
	In addition, the Health Protection Agency collects data on instances of MRSA, C. difficile and other infections from acute trusts under the mandatory surveillance system. These data are available on its website, where patients and their families can access the rates for each trust. Some information is also available on the NHS Choices website.
	Of course, the Bill already requires the commission to publish inspection reports under Clause 57(3), and Clause 80 requires the commission to make its reports available to the public, just as the current commissions do. I expect that, as now, reports will be available via the commission's website and the public will also be able to request hard copies. We intend to publish regulations under Clause 85 requiring the commission to publish certain information about enforcement action that it has taken. This means that the public will be able to access information about how the commission is using the new powers it will have at its disposal to address infections wherever they occur. Of course, the commission will also publish information on how well services are performing for the purposes of public accountability, supporting people in making informed choices.
	So, arrangements are in place for this kind of information to be made available to the public, either by the commission or others. I hope that I have reassured my noble friend that we want to ensure that the public can access information about the services they use, that the Bill will in fact strengthen these arrangements, and that he will therefore agree to withdraw this amendment.

Lord Campbell-Savours: My Lords, I am grateful to my noble friend and I shall refer her remarks to the colleague with whom I have been discussing these matters. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.
	Clause 22 [Notice of proposals]:

Lord Darzi of Denham: moved Amendment No. 22:
	Clause 22, page 11, line 35, after "than" insert "by virtue of section 13(1A) or"
	On Question, amendment agreed to.
	Clause 30 [Offences relating to suspension or cancellation of registration]:

Lord Darzi of Denham: moved Amendment No. 23:
	Clause 30, page 16, line 1, leave out subsections (2) and (3) and insert—
	"( ) A person ("M") whose registration under this Chapter as a manager in respect of a regulated activity is suspended is guilty of an offence if, during the period of suspension, M manages that activity at a time when no one else has been registered under this Chapter as a manager in respect of the activity since the suspension of M's registration.
	( ) A person ("M") whose registration under this Chapter as a manager in respect of a regulated activity has been cancelled is guilty of an offence if M manages that activity at a time when—
	(a) a person ("S") remains registered under this Chapter as a service provider in respect of the activity,(b) S's registration remains subject to a registered manager condition, and(c) no-one has been registered under this Chapter as a manager in respect of the activity since the cancellation of M's registration.
	( ) If a person ("M") who is registered under this Chapter as a manager in respect of a regulated activity manages that activity while the registration of the person registered under this Chapter as a service provider in respect of the activity is suspended, M is guilty of an offence if M knows or could reasonably be expected to know of the suspension."
	On Question, amendment agreed to.
	Clause 35 [Bodies required to be notified of certain matters]:

Baroness Barker: moved Amendment No. 24:
	Clause 35, page 17, line 41, at end insert—
	"( ) to the General Social Care Council, and"

Baroness Barker: My Lords, I do not know whether to be flattered or terrified that I have to do this in the presence of three former health Ministers with whom I have debated the existence of the General Social Care Council over the past nine years, as well as the current incumbents.

A noble Lord: Oh!

Baroness Barker: My Lords, it is such riveting stuff that it is desperately difficult to keep away.
	I return to two issues that we debated in Committee. I put my hands up to the fact that these are issues for social care anoraks, but none the less they are important in the greater scheme of things.
	Amendment No. 24 returns to the question of which bodies are notified when the commission takes action under Clause 35. We talked at length in Committee about what would happen if action were taken against an individual social care worker. I understand, following helpful discussions with the Bill team, that in Clause 35 the bodies which are required to be notified are those responsible for the provision of care. We have so far not dealt with the fact that one of the standards on which providers will be judged is that they should only use registered staff if they are to be compliant. It seems to me that if a provider is found not to be compliant because they continue to use unregistered staff, that matter should be automatically reported to the General Social Care Council. I understand that under Clause 35(1)(d), "other persons" could include the General Social Care Council, but the General Social Care Council has an importance within the field of social care, being the registering body for social care workers, so I think that it merits mention on its own.
	Amendment No. 33 returns to the assessment of social care needs. I listened very carefully to the view put forward by the noble Baroness in Committee that commissioning would involve such an assessment. I disagree with that because very many PCTs, and increasingly local authority social services departments, are divesting themselves of their provider arms. They are in future unlikely to be commissioning large volume services for users with the growth of individual budgets and self-directed care. I was interested earlier to hear noble Lords talking about local authority homes. I do not think there will be local authority homes in future. In the group of amendments on agencies, spoken to by the noble Earl, Lord Howe, we underplayed the importance of brokers who will broker care for people who are going to buy it with individual budgets. So it is not fantastic to foresee a time fairly soon when local authorities will not be commissioning care, because that will be done under self-assessment and individual budgets. It is important to ensure that social care needs are assessed, even when they are not met and even when they are not recognised through the commissioning process. For that reason, I return to these two somewhat technical-sounding issues, but ones on which the quality of social care depends quite heavily. I beg to move.

Lord Darzi of Denham: My Lords, looking first at Amendment No. 33, I agree with the noble Baroness that assessing the quality of services provided is impossible without an assessment of the needs of the population that is being served. For local authorities, both individual needs assessments under Section 47 of the National Health Service and Community Care Act 1990 and joint strategic needs assessments carried out jointly with PCTs under Section 116 of the Local Government and Public Involvement in Health Act 2007 are relevant here. Joint strategic needs assessments relate to the needs where there is an overlap between what the PCT and local authority might provide and identify the current and future health and well-being needs of the local population. Local authorities are required to carry out individual needs assessments of those individuals who appear to them to require social services.
	Both of these functions are statutory duties of the local authority and play a crucial part in ensuring the effective provision of care, especially when one bears in mind that models of care, particularly adult social care, are changing very rapidly indeed. Both could therefore be encompassed within the commission's reviews under Clause 42 or, indeed, Clause 44. Obviously, exactly what will be encompassed in those reviews will be dependent on the indicators that the commission will play an important role in developing.
	When reviewing the provision of adult social services by local authorities, the commission will assess performance by reference to a set of national indicators. These indicators will form part of the single set of national indicators to be reflected in local area agreements used in comprehensive area assessments. These indicators could therefore look at the assessment of needs as part of the assessment of the performance of a local authority.
	In addition, we have proposed that the registration requirements should include a requirement on providers of regulated activities to ensure that all people receiving services have their needs assessed, as we said in Grand Committee. In this way, not just those whose care is arranged or funded by the local authority are looked at by the Care Quality Commission, but all service users are covered. If a local authority as a provider is failing in this respect, the commission will be able to take direct action. I also reassure noble Lords that where the commission finds in its reviews that a local authority is failing in the performance of its adult social services functions, including the statutory duties to carry out needs assessments that I have mentioned, it will be obliged to inform the Secretary of State and can recommend any special measures that it considers that the Secretary of State should take under Clause 46.
	I turn to Amendment No. 24. In Grand Committee, my noble friend Lady Thornton explained that we agree with the noble Baroness, Lady Barker, on the importance of the General Social Care Council as the key body in relation to the registration of the social care workforce. I have considered the noble Baroness's concerns carefully and hope to provide reassurances. I should perhaps make it clear that under Clause 85 we anyway intend to allow the commission to make information about enforcement action publicly available.
	Obviously, in cases where local authorities are commissioning social care from service providers against which the Care Quality Commission has taken enforcement action, noble Lords will agree that it will be crucial that the commissioning body should have notice of that enforcement action, so that it will be able to commission alternative services from other provider organisations, if necessary. The same would apply to a PCT. Therefore, we have specified those bodies in the Bill. For NHS organisations, Clause 35 specifically allows SHAs and Monitor also to be notified, and this will apply where they have performance management responsibilities regarding a particular body.
	We recognise that, in contrast to healthcare, a large proportion of social care services are provided by the independent sector and are self-funded. In many, if not in the majority of cases, the commission's action will be against an organisation as a whole, rather than against a specific member of staff. In such cases, it is not necessary to require the commission to inform workforce-related bodies, such as the GSCC, as it would not fall to it to take any specific action. That said, when the Care Quality Commission has taken enforcement action against a specific person who is registered with the GSCC—for example, a registered manager who is also a registered social care worker—of course we would anticipate that the commission would inform the GSCC, as enabled by subsection (1)(d), which requires the commission to give notice of the actions specified to any other persons it considers appropriate.
	In recognition that there may well be such cases, and if the noble Baroness would find it helpful, we would be very happy to specify the General Social Care Council explicitly within the explanatory notes to Clause 35 as a particularly important example of a body that may need to be notified under subsection (1)(d). I believe it would be preferable to make this link clear but leave a certain amount of flexibility according to the circumstances rather than accept this amendment as it stands, which will require the commission to inform the GSCC about every enforcement action it takes, whether concerning a person registered with the GSCC or not. Given those reassurances, I hope that the noble Baroness, Lady Barker, will feel able to withdraw her amendment.

Baroness Barker: My Lords, I thank the Minister for that reply. I take his point about the GSCC and it is a helpful suggestion that it be referred to in the explanatory notes. On Amendment No. 33 and the periodic reviews, I welcome his statement about assessment. I will read his words carefully in Hansard. I wish to satisfy myself absolutely that what I wish to see—the assessment of all social care needs, not just those social care needs which meet eligibility criteria, which is actually what he said—is there. With that caveat, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.
	Clause 38 [Death of registered person]:

Lord Darzi of Denham: moved Amendment No. 25:
	Clause 38, page 18, line 38, after "where" insert "a person who was"
	On Question, amendment agreed to.
	Clause 39 [Power to modify Chapter in relation to newly regulated activities]:

Lord Darzi of Denham: moved Amendments Nos. 26 and 27:
	Clause 39, page 19, line 10, after "any" insert "regulated"
	Clause 39, page 19, line 25, at end insert—
	"( ) Any regulated activity carried on by or on behalf of the Crown is for this purpose a newly regulated activity."
	On Question, amendments agreed to.
	Clause 41 [Standards set by Secretary of State]:

Baroness Stern: moved Amendment No. 28:
	Clause 41, page 20, line 5, leave out "may" and insert "shall"

Baroness Stern: My Lords, I shall speak also to Amendments Nos. 29 and 31 standing in my name and in the names of the noble Earl, Lord Onslow, and the noble Lord, Lord Dubs. These amendments are proposed by the Joint Committee on Human Rights and are a very slightly amended version of amendments not moved in Committee. Currently, the Bill provides for the Secretary of State to have the power to make standards in relation to the provision of NHS care. The Joint Committee on Human Rights is proposing that "may" should become "shall" and that the power to publish standards should also apply to all health and social care. We are also proposing that these standards should include specific and detailed matters to ensure that human rights are respected. This list in Amendment No. 31 is not plucked out of the air. It is based very closely on the recommendations arising from the Joint Committee on Human Rights' inquiry into older people in healthcare. In that inquiry, the committee welcomed the existing healthcare standards which require the NHS to respect human rights and treat patients with dignity and respect. However, the committee felt that more specificity was needed. This was based very much on what emerged in our inquiry from the evidence we received and the places we visited.
	The committee considered that the human rights of residents should be explicitly addressed in the standards which apply to both health and social care to make it clear that the human rights of people in care homes are as important and as enforceable as the human rights of patients in hospital. The committee went on to make a recommendation about the Bill we are discussing today. I will quote briefly what we said:
	"We also recommend that when the Health and Social Care Inspectorates are merged the standards applicable to quality of care and other issues engaging the human rights of users of services should be the same for both NHS trusts and care homes. The unified standards should expressly require compliance with human rights standards by hospitals and care homes and state that patients and care home residents have the legal right to respect for and protection of their human rights. The newly established inspectorate should provide guidance to providers of services on the implications of such requirements".
	The Government responded to that recommendation very helpfully, saying:
	"It is our intention to introduce an integrated registration system across health and adult social care, based on a set of requirements that apply across all settings".
	In light of that commitment, I ask the Minister why the Bill currently enables the Secretary of State to make new standards for the NHS but not for social care and why the Government do not consider it appropriate to require the Secretary of State to introduce standards that will explicitly provide for the protection and promotion of the rights of service users. I beg to move.

Earl Howe: My Lords, in Amendments Nos. 34A and 34B, which are grouped here, I turn to an issue that I consider to be of fundamental significance for this part of the Bill and our understanding of what the identity and functions of the Care Quality Commission are. The issue turns on a very basic question: will the CQC be a body that actively promotes the highest standards of care and treatment in health, social care and mental health, or will it merely be a body that seeks to maintain and police a set of minimum standards that are geared to patient safety? The two aims are completely different. It is no exaggeration to say that the very character of the organisation will rest on what the answer to the question is.
	At the moment, we see the Healthcare Commission making it its business to assess the performance of NHS providers against not only a scale of quality standards but also each other in the way that trusts are ranked. The commission sees itself not just as a promoter of patient safety but also as actively assisting the drive to raise standards of care across the piece. In the same way, CSCI operates a quality rating system, which aims to achieve something very similar with social care providers.
	What prospect is there of the CQC continuing this kind of corporate mission? I was very struck when I read a few days ago chapter 6 of a document published by the Department of Health called Developing the NHS Performance Regime. The chapter covers independent regulation and says in paragraph 150:
	"The main responsibilities of the CQC are to ... register health and social care providers ... carry out a periodic assessment of all NHS providers and commissioners ... carry out special reviews of services, along patient pathways or into other areas of concern or risk in terms of patient safety ... carry out investigations into specific organisations where CQC believes that user safety is seriously at risk; and gatekeeping and proportionate regulation ... However, the principal role of the CQC will be to register health and adult social care providers".
	I do not belittle the importance of patient safety; of course not. However, the message from that to me is quite concerning; it is of a piece with the consultation document issued by the department on the framework for the registration of health and social care providers. That says, in paragraph 2.13:
	"The set of registration requirements in this consultation is intended to protect people using services from the risk of harm involved in the provision of health and social care. They do not seek to enforce best practice that other parts of the system will promote".
	It continues:
	"In moving to a regulatory system which is based on essential safety and quality requirements rather than desirable best practice standards, we propose to put a greater regulatory focus on essential outcomes and on addressing the risks".
	Taken together, these statements tell a very clear and, for me, rather depressing story. They tell us that the department is putting the CQC into a tight box marked "patient safety". The principal role of the CQC, in the Government's eyes, will be to register health and social care providers and to police and enforce a set of minimum quality standards.
	The obvious question that springs from this realisation is: what significance should we now attach to the commission's objectives as set out in Amendment No. 9? What weight should we place on the matters listed in Amendment No. 12 to which the commission must have regard? Those questions may seem surprising after our debates earlier, but if the commission's main focus is registration and safety, what added value is likely to emanate from active user involvement in the commission's work—the thing that we were all so keen on, and so glad to see incorporated into the amendment?
	Of course, these things are of key relevance if we are dealing with a regulator concerned with identifying and promoting best practice in health and social care. But contrary to the hopes of many of us, it does appear that the CQC is going to be that kind of animal. In a real sense, the powers conferred upon the Healthcare Commission and on CSCI are going to be diluted by the Bill now before us. What is the Minister's answer to this? If the CQC will not be directly promoting improvement and best practice in health and social care, who will be?
	We have heard some brave and ambitious statements from Ministers. If they are sincere about wanting the CQC to be a force for change in driving up standards, and if the amendment on objectives is really to count for something, we in Parliament ought to send out a clear signal to the commission's shadow chair. She needs to formulate a mission statement which speaks not only of registering providers and guarding patient safety—activities that set rather unambitious horizons for the organisation—but of inspiring people to do better, celebrating best practice, promulgating it and, in so doing, giving the NHS the means whereby less high-achieving health providers can pull themselves up by the bootstraps, not because they have had a regulatory sword wielded over their heads in a rather threatening manner but because they are genuinely hungry to do so. The same would apply to social care providers.
	For me, the most telling sentence in the Bill's Explanatory Notes is the one that comes under Clause 41. At the end of paragraph 192, which covers the quality standards for NHS providers, it says that:
	"The Commission has no role in monitoring or assessing compliance with these standards".
	Indeed so. That is something which I believe, even at this late stage of our debates, we should reconsider—hence these amendments.

Lord Warner: My Lords, I had not intended to speak at such a late hour, but I feel that I must raise an area of concern which has come to me perhaps a little belatedly. It is prompted by the amendment of the noble Earl, Lord Howe, and the detail of the amendment moved by the noble Baroness, Lady Stern.
	We are getting ourselves into an increasingly difficult tangle over a set of words which keep being bandied about. I will illustrate this with five or six of these words. I am grateful for the movement that the Government have made in terms of bringing commissioning to bear more in the Bill. We will be discussing that later and I need not go into it now. However, when the Government were in a less accommodating mood in Committee, one of the arguments that was used for not doing this was that they were going to use guidelines in relation to commissioning.
	We now have in play: targets for performance review, registration requirements, guidelines, indicators of quality, and standards. Even anoraks such as ourselves may, broadly speaking, understand what all those words mean. However, I have to confess that even I am beginning to struggle intellectually with how the words all relate to one another. There is an issue for the Minister—to take them back to some of his colleagues to see whether we cannot get a little more clarity about the precise relationship between these words and what they all mean. We will certainly need a glossary—as will the noble Baroness, Lady Young, as chairman of the commission, together with her colleagues—to understand the relationship between these various pieces of terminology. Before we get to Third Reading, we need a little more clarity about how these words all relate to each other, to what extent they fall under the registration requirements, to what extent they are part of a performance management regime, and to what extent they are part of the information given to the public about how particular bodies are performing. I am sorry to dump this matter on the Minister this late at night, but before the Bill leaves the House I think that we should all be clear how the words relate to each other.

Baroness Thornton: My Lords, I thank my noble friend for those largely helpful comments. The amendments relate specifically to Clause 41, which concerns the publication of statements of standards relating to healthcare provided and commissioned by primary care trusts. PCTs will need to have reference to standards issued under this clause in discharging their duty of improvement under Clause 134.
	As we made clear in earlier discussions, it is important to remember that the standards which will be drawn up under Clause 41, unlike the registration requirements on which we have been consulting, are not intended to be requirements that providers of regulated activities must meet in order to be registered with the Care Quality Commission. The registration requirements that we have been consulting on will apply to all registered health or adult social care providers, including providers of non-NHS care. Breaches of those registration requirements will result in sanctions from the Care Quality Commission.
	Through the Bill, we are seeking to establish a unified framework for the regulation of health and adult social care services. The current consultation proposes registration requirements which the new commission will be able to enforce against any registered provider of care. They have been developed in line with the spirit of the relevant provisions of the European Convention on Human Rights and cover topics including safeguarding people when they are vulnerable; ensuring that people get care and treatment in safe, suitable places which support their independence, privacy and personal dignity; involving people in making informed decisions about their care and treatment; getting people's ongoing agreement to care and treatment; responding to people's comments and complaints; and supporting people in being independent.
	Standards under Clause 41, on the other hand, will not be subject to the Care Quality Commission's enforcement powers if they are not met. Instead, they will be designed as improvement tools to help to deliver high-quality, publicly funded healthcare.
	As discussed in Grand Committee, we do not believe that the Secretary of State should be required to issue standards, as envisaged under Amendment No. 28. Standards should be issued only where it is clear from the evidence that they will assist in enabling quality to be improved, and sometimes the evidence does not allow for that. In my view—and I very much support the ambition of clear standards for all areas of healthcare—it is sufficient to give the Secretary of State an enabling power.
	We also stated in Grand Committee that we do not believe it is necessary to make similar provisions to apply to publicly funded social care, as envisaged by Amendment No. 29. Such related standards are for the Minister for Communities and Local Government to issue under the Local Government Act 1999.
	If the standards under Clause 41 are to deliver real improvements in care, they must be flexible enough to cope with changes—and indeed with improvements—in services over time and be subject to full public consultation. Consequently, to set them in legislation now, as Amendment No. 31 seeks to do, would begin to remove that flexibility and pre-empt any such consultation and engagement.
	Nor do I believe that the commission should be required to take certain standards into account in its periodic reviews of English NHS providers under Clause 42, as I understand is the noble Earl's intention through Amendments Nos. 34A and 34B. I have already made it clear that we intend to delegate to the commission the function of setting indicators for use in periodic reviews of NHS providers. It may well decide to draw on the standards under Clause 41 in determining the indicators and methodology to adopt in those assessments, but that will be for the commission to decide. We can expect to see a great deal about quality and its enforcement under the next-stage review.
	Of course, under Clause 134, PCTs will already be required to take the standards under Clause 41 into account when exercising their duty to ensure that NHS healthcare continues to improve. The commission will undertake periodic reviews of PCTs to provide an independent assessment of how effective the PCT has been in assessing its local needs and improving outcomes for its local populations. Even if the commission decides that standards need not play a direct role in periodic reviews of NHS providers, it will nevertheless have contributed to the performance of PCTs.
	I hope that I have been able to set out clearly that it is through the commission's registration requirement under Clause 16, rather than through the standards in Clause 41, that the important intention behind the amendments will be best met. I hope that with that clarification the noble Baroness will feel able to withdraw the amendment.

Baroness Stern: My Lords, I thank the Minister for that very full reply. It will probably benefit from being read at a different time of day, which I shall certainly do, but, in the mean time, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.
	[Amendment No. 29 not moved.]

Baroness Thornton: My Lords, I beg to move that consideration on Report be now adjourned.

Moved accordingly, and, on Question, Motion agreed to.
	House adjourned at 10.11 pm.